Governance is traditionally viewed as a formal authority structure. Information Technology (IT) governance parallels this in that it refers to the patterns of authority over IT. However, traditional control theories of governance, particularly those applied to IT, may not apply in rural healthcare settings. Healthcare has significantly underinvested in IT. Even today, the vast majority of healthcare transactions occur via telephone, fax, paper, and EDI; much data is not captured, is captured incorrectly or inefficiently, and is difficult to retrieve and use. Employing an established IT governance framework, and working from the fundamental assumption that IT is a vital tool in the capture and use of healthcare data, the authors explore the appropriateness of the traditional IT governance framework within a rural healthcare setting. We present an innovative, non-authoritative, relationship-oriented approach for those seeking successful adoption of IT as a means of improving healthcare in rural settings.