Palliative care (PC) has come into its own as a medical specialty, primarily for adults with serious, life-threatening, and/or chronic illness. PC has been thought to be synonymous with end-of-life (EOL) care and hospice. Typically, PC is described as being an umbrella specialty, within which EOL care and hospice reside. Both PC and hospice emphasize a palliative approach to symptom management and an interprofessional, team-based, holistic model of individualized care that focuses both on the patient and his or her loved ones. This chapter reports on the state of PC in rural settings, comparing it to what is assumed to be the standard, PC in urban/suburban settings. It presents a case study that illustrates the need for home-based PC services for chronically but not yet terminally ill patients. The chapter also describes the most commonly identified challenges for rural PC, as well as strengths and recommendations for future programs.