From January 2001 to January 2002, Broken Hill, New South Wales, served as a trial site for teledermatology as one method of access to dermatologists. Fourteen participating general practitioners referred 46 patients making up 48 teledermatology cases. The mean diagnostic agreement between general practitioners and dermatologists was 35% and 50% for primary and differential diagnoses, respectively. Teledermatology patients formed 12% of the collectively referred dermatology patients (outpatients and teledermatology). In this project, high patient and general practitioner acceptability and positive medical outcomes confirm the value of rural teledermatology. However, this project also revealed unexpected barriers and pitfalls in the effective operation of rural teledermatology. Lack of education of participants, inertia among potential users and patient inconvenience are issues that may adversely affect the effective implementation of rural teledermatology.