Living and practicing psychology in a small, rural community has opportunities and challenges. We describe the context of rural communities and identify several of those challenges and opportunities. A case study demonstrates the influence of multigenerational involvement, complex professional and social situations, and the potential difficulties facing the responsible clinician. We suggest both a theoretical perspective and specific procedures for treating prototypical cases in a rural practice. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:1–13, 2010.