This CCB provides a forum for current and potential rural child and adolescent psychiatrists to discuss challenges and concerns, explore the realities faced in a rural practice, and explore strategies for adjusting one’s practice to make it viable over the long term. Topics include availability of medical resources; the multiplicity of needs and availability of work; negotiations and contracts; limitations on clinical and financial resources; geography; population density; and ethnic, racial, and cultural diversity. Ethical dilemmas encountered when practicing in a rural area also are addressed. The use of physician extenders and the practicalities of collaborations with a range of professionals are part of the dialogue; as is building time in one’s schedule for family, continuing education, and collegial contact and support.