This chapter investigates ethics in rural mental health, which have many specific circumstances as compared with urban areas, which have their own unique situations. From boundary issues and confidentiality in the age of HIPAA, and from professional isolation to the need to be a generalist, rural mental health practitioners of all types need to learn how to blend in to their rural communities. Because there is a lack of anonymity, frequent gossip, and public scrutiny in small towns, practitioners need to know how to cope in order to thrive. If they can’t thrive, they can’t be of much help to their clients. There is little preparation in education programs for mental health practitioners for rural practice and rural life, and that needs to change.