Rural Health Clinics (RHCs) are an important source of primary care in underserved rural communities with more than 4,200 RHCs providing primary care services to rural Medicare and Medicaid beneficiaries in 44 states. In light of the growing emphasis on quality reporting, it is important to understand factors influencing RHC readiness to participate in quality reporting including the Merit-Based Incentive Payment System (MIPS), Medicaid, and commercial payer quality reporting programs. The exclusion of RHCs from the Centers for Medicare & Medicaid Services' (CMS) quality reporting programs and value-based initiatives may potentially create a perception among consumers and policymakers that RHCs are unable to meet the requirements of these initiatives and are providing lesser quality care than larger, urban-based clinicians. To inform this brief, we conducted an extensive review of the MACRA legislation and regulations, literature on RHC quality reporting and CMS RHC billing manuals, advisory and consulting reports, and monitored listserves relevant to the topic. Additionally, we conducted key informant interviews with national and state organizations associated with RHCs. This brief outlines several challenges faced by RHCs to engage in quality reporting initiatives and highlights the opportunities to support their participation in these initiatives.