The Tennessee Rural Hospital Patient Safety Demonstration Project sought to improve patient safety in small rural facilities by strengthening their capacity to implement priority patient safety interventions. The project focused on interventions relevant to the core services and capacities of rural hospitals and was sensitive to their structure and processes. A process for assessing the status of hospital patient safety programs and providing technical assistance tools, and resources was developed. Organizational and clinical changes designed to prevent errors and improve safety were initiated. Eight participating hospitals completed a self-assessment tool to identify and prioritize rural hospital patient safety interventions. These hospitals implemented three interventions: assessment of patient safety culture and implementation of a safety culture plan, development and implementation of emergency department protocols, and use of personal digital assistant devices (PDAs) by clinicians at the point of care to decrease medication errors.