Few education programs adequately prepare rural registered nurses (RNs) for "multispecialist" roles within small acute care facilities. This article describes the development of a post-RN rural acute care certificate program. To plan relevant curriculum and program delivery approaches, a series of focus groups were held with 236 rural RNs throughout British Columbia, Canada. The themes that emerged from RNs' descriptions of their everyday practice form the foundation of the new curriculum. The resulting program is practice driven and reality based, with a curriculum, teaching and learning strategies, and program delivery methods that are responsive to the learning needs of rural nurses.