In this chapter, the authors focus on the process of delivering psychological services to rural schools. They provide a thorough examination of the structure that has evolved and the manner in which services have been delivered. The authors review the historical and logistical factors that have influenced service delivery in rural areas and examine practitioners’ perceptions of rural problems and rural practice. They evaluate the apparent strengths and weaknesses of the service delivery models in place and provide suggestions for rural service providers. The authors aim to use three major conceptual dimensions of service, centralized-decentralized, direct-indirect, and proactive-reactive models which examine rural school psychological services. They outline three stages in the evolution of the delivery of psychological services to rural school children: early history, post world war II and multidisciplinary services. The authors also review the organizational and administrative structure of school psychological services at the state department level.