The rural nature of West Virginia presents many challenges in treating problem gamblers and their loved ones. Our program could not change many factors, like poverty and lack of transportation. We focused on what we hoped we could alter, like availability of treatment and the attitude toward professional treatment. Our first step was to find and train professional gambling addiction counselors. We are now proud to have a network over 100 strong of skilled gambling counselors. We will share how we developed this network, which is the largest per capita gambling treatment network in the country. Next, we had to develop a helpline. The rural nature of our state meant that the helpline call may be the only type of “treatment” many of our residents got, so we knew we had to develop something unique. We also understood that our rural culture may contribute to a hesitancy to seek professional treatment. We worked with our staff to build a culture of customer service suited perfectly to our clients. We developed a system that has led to some of the highest rates of appointment acceptance, treatment engagement, client satisfaction, and recovery in the country. We did all this while creating world class database system to track our efforts and foster research on problem gambling in rural areas. Finally, we had to create innovative programs that serve our population. We developed a one-of-its-kind “Weekend ReTREATment” program, along with a traveling intense outpatient course, and most recently, an online chat service.