Purpose: The purpose of this paper is to explore better use of pharmacists in rural communities as a partial solution to scarcity of physicians and other health care providers. It discusses expected reduction in public subsidies for rural health care and the changing market for pharmacists. The paper emphasizes the use of pharmacists as a backdrop for description of Medication Therapy Management (MTM). A pilot study of MTM is also reported. Methods: This article explores rural health access, the market for pharmacists and MTM using the literature, and economic concepts to provide historical context for this new form of health care delivery. A small case study from a university-based clinic provided primary data to demonstrate viability. Findings: MTM can augment rural health by providing care for patients who receive increasing numbers of complex medications. It helps better integrate pharmacists into primary care and holds promise as a cost-effective, if not cost-saving alternative. Conclusion: More constrained fiscal conditions are a virtual certainty going forward. The rural health community needs cost-effective health care alternatives that can prosper with lower levels of public financial support. MTM is one such option. (Contains 1 table and 1 figure.)