This chapter discusses the challenges counselors typically encounter when working in rural communities as well as suggestions for maximizing the opportunities that rural practice provides. Because of stressors characteristic of rural areas, such as poverty, single parenting, less formal education, unemployment, lack of health insurance, stigma surrounding mental illness, and inaccessible or inconsistent community resources, few opportunities may exist for receiving mental health care. In terms of mental health service delivery, Human and Wasem suggest that availability, accessibility, and acceptability are important aspects to consider in rural communities. The use of communications technology in the educational, clinical, training, administrative, and technological aspects of health care is known as telehealth. Telehealth can vary from e-mail communication to videoconferencing to more advanced computerized therapy programs. One of the most salient ethical issues in providing therapy in rural areas is that of dual relationships.