Despite tremendous challenges, in the early 20th century school nurses provided the first, and often only, medical care for thousands of schoolchildren and their families. However, multiple barriers impeded the developing role. Influences of historical events, financial support, lack of knowledge regarding benefits of the school nurse role, limited access to training, and issues of poor pay affected the Commonwealth of Virginia's attempts to develop and provide school nursing throughout the diverse rural counties across the state. School nurses continue to face these challenges today. The purpose of this social historical research is to identify, describe, and analyze the origins and evolving role of the school nurse in the rural counties of Virginia, 1900-1925; investigate how this history influences school nursing today; and offer several suggestions rooted in findings for moving the profession forward as outlined by Cowell's response to recommendations made by the Institute of Medicine.