Recruiting and retaining physicians to work in rural emergency departments (EDs) have reached a crisis level, threatening the availability of services to rural residents. In this study, a case study design was used to explore strategies that rural ED administrators use to recruit and retain physicians to work in their facilities. The study population consisted of 5 rural hospital administrators operating EDs in central Mississippi. These administrators were charged with the responsibility to recruit and retain ED physicians. The on-going staffing of ED physicians, with no lapses in coverage, was evidence that these administrators successfully recruited and retained ED physicians at their facilities. The conceptual framework that grounded this study was strategic human resource management. Semistructured interviews were used to collect data from participants, and the modified van Kaam method of data analysis was used to create and cluster themes, validate data, and to construct and describe textural meaning. One of the dominate themes that emerged from the study was the challenge of maintaining rural ED physician coverage. Deterrents to maintaining ED coverage included insufficient pools of available physicians, changing technological demands, and financial constraints. A second dominate theme permeating the study was the insufficient focus on retention of rural ED physicians. Study findings may contribute to social change by providing a replicable recruitment and retention model for recruiting and retaining rural ED physicians. The most successful strategies to recruit and retain ED physicians, as identified in this study, were provision of financial incentives and development of a sense of family and community.