Background: To provide competent membership, a board member needs knowledge of health care developments and the organization of the board. Aim: To provide information on the knowledge level of governing board members in hospitals in three northwestern states. Methods: This study included 130 hospitals with individual governing boards in rural areas of Alaska, Idaho, and Washington. As part of a larger survey of all rural hospital board members in these states, we asked board members questions relevant to competent membership on a governing board. This included questions concerning quantifiable aspects of the hospitals, planning, and financial reporting. Results: Knowledge on the part of the board members was strongest in the areas of the role of the governing board, planning, and scope of services. Board members were less able to quantify the capacities and utilization of services at their hospitals. Results were mixed in the area of knowledge of financial management. Length of service on the board and efficient board structures were associated with increased knowledge. Conclusions: While board members were knowledgeable about their roles and the services offered by their hospitals, their knowledge base in certain other crucial areas was limited, underscoring the need for programs that facilitate board member training. Funded by HRSA’s ORHP.