For victims of domestic abuse in rural settings, social support, community contacts, and knowledge of and access to health and social services are limited. Another complicating factor is the traditional attitudes of rural residents that support patriarchal family dynamics in which the male is the supreme head of the household, to whom all family members must be obedient. Responding effectively to victims and perpetrators of sexual assault and intimate partner violence in rural communities challenges forensic nurses involved in both practice and research to expand their knowledge and expertise that will enable them to be flexible in their approaches to cases, develop community-level intervention, collaborate with other agencies and professional disciplines, assume advocacy roles, and deal with economic limitations. Currently, approximately 25 percent of Americans live in rural communities with fewer than 2,500 residents. These rural communities are characterized by lower rates of personal income, educational attainment, health insurance coverage, access to emergency and specialty care services, and reported health status of adults compared to urban communities. Rural settings are attractive to the antisocial criminal or abuser who is compelled to control others because of geographic and psychosocial isolation. The rural abuser typically has more children than his urban counterparts and often binds his partner to the isolated setting. 32 references