The purpose of this study was to investigate factors that affected occupational therapy practice in the rural regions of the Rocky Mountains. It compared data from the Rocky Mountain region (Wyoming, Colorado, New Mexico, Utah, and Arizona) to a previous study of the Northwest region of Alaska, Idaho, Montana, and Washington and expanded on the Northwest study. Results indicated that the two areas were similar in their demographics and problems, including need for more occupational therapists. The results also have implications regarding specialized preservice training for rural-based occupational therapists, other professions’ availability of continuing education, and other support systems. The authors provide recommendations based on the results, other literature, and conjectures, for recruitment, training, and ongoing support of rural occupational therapist through cooperative consortiums and distance learning.