Health professionals share a common interest in improving the quality of healthcare provided to the notion's underserved citizens, many who live in rural areas. This article examines the quality of radiology services found in rural Texas hospitals as reported by radiology managers through online survey research in terms of staffing, radiologist availability, and quality control measures. A 22 question survey was developed and 72 of 106 possible responses were obtained for a 67.9% response rate representing 45% of the total population. Texas is a licensure state for radiologic technologists. Texas rural counties with fewer than 50 thousand citizens have only 9% of MRTs, 10% of LMRTs, and 12% of NCTs licensed to practice radiology imaging. Licensing all three levels of technologists through the some administrative body could result in more standard educational and training requirements, thereby increasing the quality of care given by these individuals. Patients seen at lower-volume rural facilities benefit from convenient scheduling and lower prices and are beginning to see faster reporting with the prevalence of teleradiology and voice recognition dictation.