As artificial intelligence (AI) becomes a standard tool in health care, rural hospitals risk falling further behind in the digital divide. Many rural facilities lack the patient volume, technical expertise and resources needed to adapt externally developed AI models, build their own, or maintain them over time. New data shows that smaller, independent and critical access hospitals are struggling to keep pace with their peers in adopting AI technologies. Without intentional governance and implementation strategies tailored to rural realities, these communities may miss out on AI’s potential to improve clinical outcomes and operational efficiency. This Knowledge Exchange e‑book examines how rural health care leaders can design AI governance frameworks that reflect the unique challenges of rural care, ensuring equitable access, sustainable deployment and long‑term impact.