Access to home health in rural areas is an important public policy concern, particularly with the growing number of older adults residing in rural America. This qualitative study seeks to better understand how home health services are provided in rural areas, and identifies facilitators and barriers to providing care. Rural home health agency administrators and discharge planners reported a variety of challenges with providing home health services to rural Medicare beneficiaries, including insufficient reimbursement, Medicare requirements, and recruiting and retaining an adequate workforce. External financial support, affiliation with a hospital, integrated EHR systems, and strong relationships with hospitals were identified as facilitators for providing rural home health services. The facilitators and challenges identified in this study offer insights about the delivery of home health services in rural communities that should be considered by policy makers, innovators, and providers as rural healthcare evolves.