The shortage of well-trained psychiatrists in the public sector is particularly severe in rural states, where state hospitals are often isolated from the professional resources available in cities. The combined department of psychiatry at the University of Nebraska Medical Center and Creighton University in Omaha has developed a residency training program at a rural state hospital 150 miles away. To bridge the distance, residents attend classes in Omaha once a week and faculty supervisors fly to the hospital once a week. Residents at the remote facility are subject to the same evaluation procedures used for residents at other facilities. The author describes the role of charismatic individuals in initiating the state-university collaboration, addresses the need for a structure to support the relationship in the absence of its founders, and discusses accreditation of residency training programs based in facilities that are remote from the medical school campus.