BACKGROUND: This doctoral project describes an occupational therapy clinic created by this author within an outpatient health center located on a rural reservation serving the Navajo Native-American community residents. This was the center’s first occupational therapy program. Occupational therapy services included community outreach activities and innovative approaches that were inclusive, culturally appropriate, and client-centered. PROBLEM: Some challenges occurred during the implementation of the occupational therapy program such as: client resistance, cultural differences, lack of public transportation to the reservation, little to no awareness of occupational therapy, and limited funds and resources. METHODOLOGY: A thorough literature review on developing healthcare programs in rural areas was performed to collect relevant information on current methods and approaches. Moreover, programs that incorporated cultural orientation programs and awareness was taken into consideration to develop the occupational therapy program and its activities. This facilitated building a positive rapport and relationship with the Navajo community residents. RESULTS: Innovative approaches were developed to help reduce some of the barriers. Four key program elements were chosen to focus on developing a sustainable and culturally appropriate operating occupational therapy clinic to serve the Navajo Native Americans living on a rural reservation community. Collaboration with pertinent stakeholders, integration of some of the population’s cultural values, conveying cultural respect, and including community outreach events helped the development and operation of the new occupational therapy program. IMPLICATIONS: The development of the new occupational therapy clinic provided several occasions for the clinician to integrate culturally-based activities when providing services to an underserved community. It was able to set an example for future occupational therapy practitioners to create an academic course (and/or internship) to educate students about providing occupational therapy services to an indigenous population.