Telehealth, the use of information communication technologies to deliver health care over distance, has been identified as a key mechanism for improving access to health services internationally. Canada is well suited to realize the benefits of telehealth particularly for individuals in remote, rural and isolated locations, many of whom are of Aboriginal descent. The health status of Canada's Aboriginal population is generally lower than that of the non-Aboriginal population emphasizing the need for new health care solutions. The challenges associated with implementing telehealth are not unique to Aboriginal settings but, in many instances, are more pronounced as a result of cultural, political and jurisdictional issues. These challenges are not insurmountable however, and there have been a number of successes in Canada to serve as a blueprint for a national strategy for sustainable Aboriginal telehealth. This review will highlight challenges and successes related to telehealth implementation in Canadian Aboriginal communities including: geography, technical infrastructure, human resources, cross-jurisdictional services, and community readiness. The need for champions within government, community and health care settings and the use of a needs-driven and integrated approach to implementation are highlighted. Several Canadian examples are provided including lessons learned within the MBTelehealth Network.