Nurses can take a leadership role in the process of helping rural Americans to recognize and implement their vision of a healthy community. This necessitates an understanding of rural communities' perceptions of health and health care and allows nurses to more appropriately provide primary health care. As defined by the World Health Organization, primary health care is comprised of concepts of essentiality, community participation, intersectoral collaboration, access, and empowerment (Barnes et al., 1995). A focused ethnography involving 150 residents was conducted in a midwestern rural community and included 56 personal and 8 focus group interviews. A qualitative analysis of responses to the question, "What is your vision of a healthy community?" was conducted using Leininger's (1985) categories of economics, social-kinship, cultural, political-legal, religion, technology, and education. An eighth category of environmental concern emerged from the data. Responses were further assimilated into descriptive statements reflecting the community's vision of a healthy community, including issues of accessible and technologically adequate healthcare, job availability, strong community support by schools and churches, a caring community membership, and an attractive, pollution-free environment. This analysis demonstrates the need for application of primary health care at the level of community in designing services to achieve healthy rural communities.