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Palliative care consultation is associated with reduced health care costs and improved quality of life while reducing length of stay. Small rural hospitals lack the depth of multidisciplinary resources to provide inpatient palliative care consult services. The purpose of this research was to assess the need for palliative care service in rural hospitals, while examining for a difference in hospital readmission rates in hospitals lacking palliative consult services. Data were obtained from the Pennsylvania Health Cost Containment Counsel including 3 hospitals with palliative programs and 3 without. Inclusion criteria were admissions for a patient carrying a diagnosis appropriate for palliative consultation between the last quarter of 2014 and 2015. There were 1394 index patients admitted to 3 rural hospitals lacking a palliative consult program. There was a higher rate of readmissions at the nonpalliative hospitals, 71.6% versus 55.1% (P < .001). Data suggest there is a need for palliative telemedicine services to meet needs in rural hospitals.