Public health in the United States began as a largely urban phenomenon, dating back to the late 1700s. In those days, public health was mostly concerned with issues such as sanitation and communicable diseases, which were of greater concern in areas with higher population density. By the late 1800s, however, it was apparent that the country's population was becoming more mobile and communicable diseases were beginning to spread from urban dwellers to rural dwellers, creating a need for rural public health services. Beginning in 1908, local governmental public health began to expand its reach into rural areas, with county health departments developing rapidly until the mid-1940s. Following the passage of the Hill-Burton Act in 1945, which funded the construction of community hospitals, rural health focus shifted almost exclusively to ensuring access to healthcare services. This article provides a historical context for rural public health service delivery and a beginning discussion of implications for contemporary rural public health practice.