A trend in medical schools across the United States is the refurbishing of histology laboratories with digital microscopy systems. Although such systems may reduce curricular time, they do not teach basic microscope skills, and students who learn solely with these systems may be less prepared for their practices or specialties, particularly in rural areas that may not be equipped with digital microscope technology. At the West Virginia School of Osteopathic Medicine (WVSOM), students are trained to practice in a wide variety of environments, especially rural areas. A research survey was conducted to gather information for evidence-based decisions about histology education at WVSOM. The survey asked a range of questions concerning histology knowledge, tissue preparation, and microscopy. Responses did not differ significantly between physicians in urban versus rural practices. Ninety percent of physicians do not utilize digitized images, and only 50% have microscopes readily available. Regardless of the technology available, 90% feel that students must have microscope training and 88% of physicians feel that histology is important to the medical curriculum and use their histology knowledge often (weekly or daily) (66%). These results demonstrate that histology education should move toward a blending of traditional microscope and glass slides with computer-based instructional technologies. (Contains 1 table and 2 figures.)