Background: Literature about rural health providers has focused largely on physicians, mid-level providers, and hospitals and their administrators, but little has been written about the boards that govern those hospitals. Aim: To describe the role and composition of rural hospital governing boards. Methods: Hospitals in Washington, Alaska, and Idaho were included in this study. Surveys related to hospital governance were administered to rural hospital board members and board chairpersons of urban and rural hospitals. Results: Board members were typically white males over the age of 50 and retired. They served an average of seven years and most typically brought business and management expertise to their positions. Board members contributed more than a dozen hours per month to board business and attended about 90% of their board and committee meetings. Fewer than one in four rural hospital board chairs indicated his or her board had a formal recruitment program, and fewer than half of the boards spent more than three hours on board member orientation. Board chairs were more likely to rate highly the performance of other community leaders, as well as members of the medical staff. Conclusions: Boards are attracting the service of individuals who are well educated, experienced, and willing to contribute more than a dozen hours a month to their board service. However, small rural boards are not investing enough time and funds in orientation and training. Funded by HRSA’s ORHP.