The purpose of this evaluation study was to learn more about psychiatrists' satisfaction with telepsychiatry. Telepsychiatry will succeed only if psychiatrists are satisfied with this service delivery method and offer it to their patients. While telepsychiatry appears to be effective and most patients report that they are satisfied with it, less information is available about factors that lead to psychiatrists' satisfaction. We interviewed psychiatrists who treat rural/frontier patients and asked them to describe factors that encouraged or discouraged their use of telepsychiatry. Only 4 were mostly satisfied with telepsychiatry and all offered suggestions for improving this delivery method. Most agreed that it was a hardship for many of their patients to travel 100 to 750 roundtrip miles over a 1-3 day period for a 20-minute consultation and that telepsychiatry could be a lifeline to many of them. Nevertheless, they identified significant technical and interpersonal barriers that discouraged their use of telepsychiatry.