Hurricane Rita hit the Louisiana and Texas coasts on September 23, 2005, resulting in the mandatory evacuation of underlying parishes and counties in these states. For the medically fragile, numerous medical special needs shelters were established to accommodate evacuees who were too frail to reside in a general needs shelter but not so fragile as to require hospitalization. This article offers observations of a licensed counselor who provided crisis counseling to evacuees at a shelter in Lafayette, Louisiana, after the hurricane. The narrative places emphasis on the facility origination processes, site descriptors, counselor credentials, confidentiality, and evacuee follow-up. This article also presents three case studies.