Context: Few studies have examined pharmacists' level of patient care competence and need for continuous professional development in rural areas. Purpose: To assess North Dakota pharmacists' practice setting, perceived level of patient care competencies, and the need for professional development in urban and rural areas. Methods: A survey was mailed to all 686 North Dakota pharmacists and included items regarding practice setting, competency areas, and the need for certificate programs. Findings: Overall, 401 of 686 (58.5%) surveys were returned and 364 responses were usable. Three practice settings (independent community pharmacies [47.3%], chain stores [13.2%], and hospital pharmacies [22.8%]) comprised 83.3% of the sample. More independent community pharmacists were located in rural areas than urban areas (P less than 0.01). More respondents had a Doctor of Pharmacy (PharmD) degree in urban areas (40.8%) compared to those in rural areas (15.1%) (P less than 0.01). Pharmacists in urban areas rated 18 of 33 competencies higher than did pharmacists in rural areas (P less than 0.01). Pharmacists with a Bachelor of Science degree reported a lower level of preparation than did PharmD trained pharmacists. Although not statistically significant, 28.2% of pharmacists perceived a patient care certificate as a need and a greater percentage were from rural than urban areas. Conclusion: The findings should be interpreted to be primarily due to differences in practice setting and degree earned that were most prevalent in urban and rural areas. Training mode needed most is through the certificate program, particularly by rural pharmacists who reported a lower level of preparation on perceived patient care-related items than did urban pharmacists.