Background: Given relatively less favorable health outcomes in rural Alabama, electronic health records (EHRs) have an even greater potential to improve quality and alleviate disparities if meaningfully used. Objectives: We examined rural-urban differences as it pertained to perceived barriers, benefits, and motivating factors of EHR implementation. Methods: We used multivariate logistic models to analyze data collected from a state-wide, selfcompleted survey of health information management directors in Alabama hospitals. Results: Findings from our analyses indicate that fewer rural hospitals (8%) have implemented EHRs as compared with urban hospitals (18%). Rural hospitals were 71% less likely to consider reduction in costs as a benefit of EHRs (OR = 0.29), and were 75% less likely to consider lack of structured technology as a challenge factor of EHR implementation (OR = 0.25). Conclusion: Promotion of EHRs in rural areas is challenging but necessary. Understanding perceived barriers and motivating factors of EHR implementation among rural hospitals can inform policy decisions, especially in light of recent meaningful use initiatives. © Schattauer 2011.