The ability to manage the delivery of all types of client care, nursing and nonnursing, inpatient and outpatient, in a rural setting of broad-based generalist care. A survey of department heads in a variety of practice settings found that respondents from facilities with less than 300 beds were more likely to be responsible for additional departments, along with nursing, making cross-disciplinary management skills essential for rural nurse executives. Nurse administrators in smaller facilities spend more time on marketing activities, community events, and direct patient care than urban managers (Purnell, 1999). Rural nurse executives are involved in every aspect of operations across a comprehensive continuum of care, from primary to acute to long-term. Such integrated organizations are more financially viable and more successful in meeting community needs. Case management programs can be efficient care delivery systems in rural areas. Case management in the rural community is unique, with a broad, diverse scope of practice that blends individual case management with disease management activities and community interventions (Stanton & Packa, 2001). Nurse executives must be prepared to work closely with interdisciplinary services to ensure prompt discharge processes in both inpatient and outpatient settings. Ongoing education of nurses is required to maintain consistent application of case management principles at every stage of service.