The primary telehealth technology described in these articles is interactive video teleconferencing (IVTC), which allows parties at both ends of the communication to see and hear each other. The author have used this application during the past decade for consultation with rural practitioners and schools, and it has become a primary focus of our work in Washington State. The purpose of this report was not to contrast on-site versus IVTC consultation, but rather to show how these modalities can complement each other in improving special education services in rural districts. The increase in referrals for behavior disorders and in consultation questions about autistic spectrum diagnoses are reflective of nationwide trends for these disorders. An analysis of referral patterns for both IVTC and on-site consultations showed that providers tended to use onsite consultation for strictly medical problems (e.g., neuromuscular, sports injury, infectious diseases, dermatology, endocrine, cardiology), although follow-up visits for such conditions were often conducted via IVTC. In the consultations studied, IVTC was used predominantly for patients with psychiatric diagnoses or mixed medical and psychiatric diagnoses. (Contains 2 figures and 2 tables.)