This study examined how a rural setting impacts screening and treatment of metabolic syndrome (i.e., diabetes, cardiovascular disease, obesity) in adults with schizophrenia. Seven consumers with schizophrenia and metabolic syndrome, as well as 7 primary care and 7 psychiatric providers (21 total participants) from 2 rural communities, participated in semistructured qualitative interviews. Many barriers and facilitators to effective care were similar to those reported in urban environments. Issues unique to rural communities included fewer primary care providers willing to treat people with schizophrenia, fewer medical specialists, a lack of public transportation, geographic barriers, fewer financial resources, and high rates of unemployment and poverty. Strengths unique to rural communities included familiarity (between medical and mental health providers, and providers and patients), providers who were willing to “go the extra mile” for patients, many informal social supports, and the relaxed atmosphere of rural communities. Aside from financial and practical limitations, participants indicated that strategies to improve screening and treatment such as onsite phlebotomy and integrated primary care were feasible in rural communities. Addressing barriers that are common to urban and rural settings, as well as those that are unique to rural communities, is necessary to improve metabolic syndrome screening and treatment for this high risk population. Additionally, treatment models that build on the unique strengths of rural communities are most likely to be effective.