To assess the capacity of rural hospitals to implement medication safety practices that reduce the likelihood of serious adverse drug events, a national telephone survey of a random sample of rural hospitals was conducted in March to May 2005. A total of 387 hospitals responded to the survey for a response rate of 94.6 percent. Pharmacists were asked about the hospital's pharmacy staffing, use of technology, implementation of protocols and medication safety practices, and medication safety priorities. The results of this study indicate that many small rural hospitals have limited hours of on site pharmacist coverage. The majority of hospitals surveyed are using pharmacy computers, but a significant proportion either do not have a pharmacy computer or are not using it for clinical purposes. Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve.