This study described the tenure, rate of and reasons for turnover of hospital administrators, and tracked the career trajectories of rural hospital administrators. The study was performed in partnership with the WAMI Area Health Education Center and the Washington State Hospital Association. Resumes from all Washington State hospital administrators contrasted the education and professional backgrounds of rural and urban administrators. A survey of all regional rural hospital administrators who left their position during the past three years provided information on hospital characteristics, reasons that they left, effects on the hospital and community, evaluation of their performance, and gaps in training. Questionnaires were sent to a hospital board member in the same community to ascertain why the administrator left, consequences of the departure, and adequacy of the administrator’s performance.