Better coordination of patient care is an increasingly important part of not only advanced primary care models but also of broader strategies to create shared accountability across providers and care settings. States seeking to promote care coordination, either within Medicaid or through participation in multi-payer initiatives, will run into long-standing challenges to delivering care and promoting health in rural areas. Rural areas often experience disparities in access to care, health status, and available infrastructure relative to their urban counterparts. This issue brief draws from the experiences of six states, Alabama, Colorado, Montana, New Mexico, North Carolina, and Vermont, to identify common policy considerations and action steps for coordinating care in rural environments.