Despite enduring and unacceptable disparities in health outcomes for Aboriginal and Torres Strait Islander Australians as well as people living in rural and remote locations, evidence indicates that health services are not routinely evaluated. This article describes an exploration of a context where evaluators and community partners have achieved considerable success in implementing and sustaining ongoing monitoring and evaluation for enhanced service effectiveness in rural and underserved communities of New Hampshire. The purpose of this project was to establish the principles supporting this success and to set the stage for future research investigating the applicability of these principles to the remote Australian context. Semistructured interviews were conducted with 15 people from different organizations and in different positions within those organizations. The results invite a reconsideration of the way in which evidence-based practice is conceptualized as well as the role of external evaluators. The study has important implications and recommendations for both policy and practice.