The Ohio State University Medical Center, a large urban academic medical center, and Mary Rutan Hospital, a rural community hospital in Logan County, Ohio, have been linked through a series of scholarly engagements spanning more than thirty years. What emerges from a qualitative study of key informants with personal knowledge of this interaction is a complex web of relationships, built with perseverance one strand at a time and marked by explicit agreements from time to time--always evolving, ever fragile, yet remarkably strong. The continuing dialogue around a scholarship of engagement must include the perspective of those on the outside reaching in, recognizing the important contributions of the engaging community. The scholarly activities of academic medical centers, even in the post-Boyer days of scholarship broadly defined, often seem a world apart from the day-to-day activities of rural medical practice (Boyer 1990; Fear and Sandmann 2001-2002). Nevertheless, individuals and institutions in these two environments have bridged the gap between the "high ground" of academia and the "swamp" of clinical work, engaging each other in collaborative projects that have been sustained over many years (Schon 1987, 3). Such interactions could be characterized in postmodern terms as the fusion of academic and praxis (Fear et al. 2001). These relationships are foundational to "restoring the social contract between medicine and society" and addressing the "quality chasm" described by the Institute of Medicine (Ludmerer 1999, 399; IOM 2001). One such relationship is that between Mary Rutan Hospital and the Ohio State University Medical Center.