We surveyed emergency department directors at 56 Missouri hospitals about availability of ultrasound equipment, primary uses for ultrasonography, and factors that could increase ultrasonography use in the emergency departments. Results indicated large-sized hospitals, typically in urban areas, used ultrasonography more than medium-sized or small-sized hospitals. Lack of ultrasound equipment and appropriately trained physicians contributed to limited use of ultrasonography in small-sized hospitals, typically in rural areas.