The ability to communicate a comprehensive, integrated vision and lead a rural organization to achieve its goals as a unified team. The difficulties that plague health care in general tend to be intensified in rural areas, making progressive, visionary leadership an important component of the administrative role (Carpenter, 2001). Executive nurses from both urban and rural hospitals list leadership as their most important role (Murray et al. 1998). Building a team that works toward a common goal is a challenge in any environment, easier to say than it is to do. Fitzpatrick (2001) emphasized that successful leadership begins with trust, including leading by example, maintaining integrity, establishing clear, open, honest communication (overcommunicating if necessary), being available, visible and direct, and thriving on relationships. Elements of leadership such as these transcend community settings. Another aspect of rural leadership is the role that healthcare facilities and their executives play in the community. Hospitals and their administrators are often highly visible to the