The case describes the development of the Alaska Federal Health Care Access Network (AF-HCAN), a consortium providing telemedicine in Alaska. Given the state’s vast geographical areas, the lack of infrastructure in the remote villages, and the extreme climate, AFHCAN faced particular challenges in ensuring access to quality health care across its target area. Using federal funds, a consortium of federal, military, and private organizations developed an intuitive, easy to use, custom-developed software and an integrated (cart-based) hardware platform. Low utilization levels following the initial deployment, prompted an organizational change from delivering a software/hardware product to delivering a turn-key system (including training). The system has been successfully deployed to 260 sites in the state. Users with limited computer literacy levels and even with limited English language skills are able to use the systems successfully. Overall, both patients and heath providers report high levels of satisfaction with the system.