Access to appropriate healthcare services in rural and remote communities in the U.S. continues to be a challenge. One-way health systems have been able to increase access to healthcare services in these communities is through telemedicine programs. Advances in technology have made it easier to provide telemedicine services, but the actual value of telemedicine programs for health systems providing services or for patients has not been firmly established. This project included a non-exhaustive review of recent literature and interviews with informants at three large health systems to explore their organizations' strategies, and their approach, for engaging in telemedicine to support rural healthcare. Several important themes emerged from the project's activities. A number of telemedicine services can benefit rural areas, including tele-ED (emergency), tele-stroke, and tele-ICU. Specialty services such as these can be difficult for rural areas to obtain or develop because of insufficient patient volume or inability to recruit providers, and telemedicine can help address these needs. Some organizations have been able to effectively scale telemedicine to reach revenue neutrality or even net revenue generation, but the scale required to do so is significant; thus, the interviewed organizations tend to view telemedicine more as a cost minimization strategy than as a strong revenue generator. Their telemedicine programs originally grew organically, addressing specific community requests and needs, but the organizations are now taking a more strategic look to determine the best approaches to expansion of services and geography.