This article describes a rural self-directed care program for adults with diabetes. The intervention consisted of coordinating with primary care clinics, six 2-hour facilitated educational peer groups, communication with physicians, referral tracking and follow-up, telephone support, and cooking demonstrations. The educators minimized lectures and they allowed content to emerge from participant questions and concerns. The program provided culturally tailored written educational materials. The author identifies theory and process issues for designing a diabetes self-directed care program in rural settings.