This report describes four case studies that highlight the strategies employed by Quality Improvement Organizations (QIOs) to help small rural hospitals implement successful quality improvement initiatives. These case studies are presented with the goal of describing successful QIO-hospital relationships, where success is measured in terms of quality improvement. These relationships are spotlighted to emphasize the value that rural hospitals derive from the technical assistance offered to CAHs and small rural providers. This study was conducted by staff at Social and Scientific Systems, Inc., under contract to the NORC Walsh Center for Rural Health Analysis.