The management of chronic illness presents unique challenges within and among rural regions. Rural persons with chronic illness have unique health care access challenges related to available health care personnel to provide services, distance to services, and fiscal resources to obtain services. Unique attributes of rural persons with chronic illness require continued study to enhance health care providers' understanding of how to support their relative health, well-being, and effective utilization of health care resources. Nursing leaders in rural settings are in a critical position to provide guidance and leadership to the challenge of managing this vulnerable population.