Occupational therapy practice in rural schools is influenced by a number of factors unique to rural settings, such as geographic barriers, cultural diversity, limited access to external resources, and lack of personnel with specialist skills. The purpose of this ethnographic study was to identify the unique experiences of occupational therapists who practice in rural schools and to explore how they perceived their roles in rural schools. Six occupational therapists were interviewed and observed in the field. Analysis of interview data revealed five themes: (a) jack-of-all-trades, which described how the participants viewed themselves as generalists; (b) bridging the span between services, which described their roles in coordinating the students’ medical services, which tended to be disjointed; (c) the world can get kind of lonely out there, which described the sources of support seen as reducing their sense of isolation; (d) trust and teaming, which described their attempts to provide an integrated intervention service and the challenges they faced; and (e) I cannot do it all, but I wish I could, which described how they selected their service delivery models to meet the demands of their practice. The participants believed that their work in rural schools required creativity, resourcefulness, and self-reliance. These characteristics, as well as support from their colleagues, were important to coping with the challenges of practice in rural schools.