Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications were referred to a clinical pharmacist by the physician or nurse practitioner for medication assistance evaluation. Once patients were deemed eligible, the pharmacist assisted in the PAPs completion process, maintained detailed records, and aided in recovery of refills. Patients paid $5 per application to cover office supply costs. An annual retrospective review was performed each December to evaluate the monetary value of free medications provided to patients during this 24-month period. Findings: One hundred forty-two applications were completed, enrolling 31 patients in 22 PAPs. Patients received $138,400 worth of medications; the clinic collected $710 in fees. Antihypertensive, antidepressant, lipid-lowering, antiplatelet, and proton pump inhibitor medications were most frequently prescribed and represented 74% of the total monetary value of free medications provided to patients. Clopidogrel (Plavix) and esomeprazole (Nexium) were the most commonly requested medications, representing 16% of the monetary value. Conclusions: PAPs offer an avenue to obtain medications when cost may lead to non-adherence. PAP services helped rurally isolated Alabamians receive needed therapies they otherwise likely would not have purchased. Similar programs offering assistance services for merely cardiovascular products would provide a substantial public health impact. Providers interested in initiating similar services should identify a program coordinator, designate a private location for patient interviews, and develop systems to ensure patients receive their PAP medications.