The United States is in the middle of a gripping nursing shortage; a shortage that is putting patients' lives in danger. This study determined the impact community and tribal colleges in severely economically distressed counties of the United States have on the nursing shortage faced by health care facilities serving these areas. The initial sample of 24 institutions selected in the Ford Foundation's Rural Community College Initiative (RCCI) (1995-2000). Data were collected from the Fall 1998 National Study of Post Secondary Faculty to obtain characteristics of faculty and from the 2003 Integrated Postsecondary Education Data System (IPEDS) to obtain characteristics of students, both at all publicly-controlled community colleges, all tribal colleges, and the 24 RCCI colleges that included 18 community and six tribal colleges. A survey was sent to the directors/deans/chairs of the nursing programs to ascertain issues related to the nursing program, nursing faculty, and nursing students. Respondents were asked to identify the healthcare facilities used for students' clinical experiences. A survey was then sent to each of these facilities asking about rural health, and source of nursing staff. Findings: 1) 87% of these these rural healthcare facilities are experiencing a significant shortage of nurses, and they are challenged to recruit and retain nursing staff; 2) Nursing programs, including both Licensed Practical Nursing and Associate's Degree Nursing are important to these rural community and tribal colleges, have seen growth over the past 5 years and expect to continue growth (86%); 3) Financial aid for nursing students is critically important; 4) Students are predominantly white and female; minorities are significantly under-represented; 5) Lack of subsidized public transportation and child care for nursing students even at tribal colleges are barriers that impact program completion; and 6) A shortage of nursing faculty exists at rural community and tribal colleges that negatively impacts student enrollment in these programs, thus reducing the rural nursing workforce pipeline. It is the rural community and tribal college nursing programs help provide severely economically distressed counties of the United States with the nursing workforce needed to decrease the nurse to patient ratio.