Rural health clinics (RHCs) provide primary health care services to the medically underserved in US rural areas. Although they face unique operational challenges, little research has been conducted to identify factors that contribute to RHC performance (efficiency and effectiveness). To identify such factors as viewed from a management perspective, focus groups were conducted of a national random sample of RHC administrators and managers. Factors identified as contributing to RHC efficiency were (1) sufficient and competent staff and (2) technology, particularly electronic medical record systems. Those contributing to RHC effectiveness were (1) ongoing communication with the community and (2) cooperative and/or satisfied staff.