The Northeast Conference on Rural HIV Service Delivery was attended by 51 health and social service professionals, people with HIV, and federal and state health officials with expertise or interest in developing HIV care capacity in rural areas. Low population density, low prevalence of HIV/AIDS, rugged topography and climate, and limited health care infrastructure were identified as access barriers for rural people living with HIV. Three models presented for delivering health and support services to rural residents with HIV were urban outreach, community-based physician networks, and shared care. HIV continuing professional education programs for rural providers should be responsive to local variations in health care delivery, time effective, case-specific, and provided at little or no cost. Rural areas need primary care physicians and mid-level practitioners who are trained to recognize the signs and symptoms of HIV infection and to work with HIV specialists. Linkages with urban-based specialists need to be strengthened through telemedicine, telephone consultations, and visits by specialists to rural sites. Rural areas also need to plan for changes in HIV care that may be required by changing Medicaid policies and payment arrangements. Funding and training are needed to provide the higher levels of support required by increasing numbers of HIV-positive patients with chemical dependence, mental disorders, and hepatitis C. Resources were identified to help rural areas develop HIV service capacity. (TD)