In this paper, we describe the planning, development, and overall impact of Electronic Medical Records (EMRs) on Dryden Family Medicine (DFM), a rural family practice in Dryden, New York. The EMR system was installed in July, 2003, and the full conversion to the new system was accomplished in three phases. Significant efficiency gains were achieved in billing, prescription ordering, and other routine processes. Protocols were developed to enhance quality management, preventive medicine, and disease management. Job responsibilities changed and expanded for all members of the practice and coding issues became paramount. Practice revenue increased by about 20 percent and average "case-mix" increased by 10 percent in the second year following the implementation of EMRs due to improved billing documentation. We focus on the implementation process, the lessons learned, the obstacles encountered, and the successes achieved by one rural family practice.