Background: The Indian Health Service (IHS) expenditure for American Indian and Alaska Native (AI/AN) health services is less than half that spent per year on the U.S. civilian population. Many AI/ANs, especially in rural areas, depend on the IHS as their only source of funding for health care. Specialty services may be limited by a low level of contract funding. Aim: To examine access to specialty services among rural AI populations. Methods: A mail survey addressing access to specialty physicians, perceived barriers to access, and access to nonphysician clinical services was sent to primary care providers in rural Indian health clinics in Montana and New Mexico and primary care providers in rural non-Indian clinics within 25 miles of the Indian clinics. Results: Substantial proportions of rural Indian clinic providers in Montana and New Mexico reported fair or poor access to nonemergent specialty services for their patients. Montana’s rural Indian clinic providers reported poorer patient access to specialty care than rural non-Indian clinic providers, while New Mexico’s rural Indian and non-Indian providers reported comparable access. Indian clinic providers in most frequently cited financial barriers to specialty care. Indian clinic providers in both states reported better access to several nonphysician services than non-Indian clinic providers. Conclusions: Access to specialty care for rural Indian patients is limited, and is influenced by the organization of care systems and financial constraints. Funded by HRSA’s FORHP.