Interested family physicians with proper training and minimal extra equipment can now employ transvenous pacemaking. Some cardiac centers have developed training programs for general internists and family physicians. We believe that this valuable procedure can, with proper physician training, be offered to patients in rural areas as well as in cardiac centers. While the number of patients in this rural family practice who require this procedure has not been great (ten patients in four years), the need is often urgent when it does occur. Use of this treatment modality with consultation in a 44-bed hospital was found to be safe and practical, although sometimes technically difficult. This paper describes the training, techniques used, results, and complications in a rural community in southeastern Nebraska. It is suggested that every hospital caring for seriously ill cardiac patients should have at least one physician trained to perform this emergency procedure.