Traditional leadership is becoming rarer while distance or virtual leadership is more common because advancing technologies can support new models of health system communication. Successful virtual leaders learn how to cross time, space, and culture barriers to make improvements across small and large entities. The challenges of virtual leadership are the same as traditional leadership, but occur in a much different venue where direct supervision and interaction are impossible. It is a difficult adjustment for some leaders to move from traditional leadership modalities to the skills necessary for virtual leadership. New skills of creating a high-performance group across diverse boundaries are necessary.