With the support of the Federal Office of Rural Health Policy (FORHP), the National Rural Health Resource Center (The Center) developed this report to assist rural hospital leaders in navigating changes in the new health care environment.  This report builds upon the knowledge gained from the Critical Access Hospital 2012 Financial Leadership Summit and includes key strategies discovered through the Small Rural Hospital Transition (SRHT) Project’s Rural Hospital Toolkit for Transitioning to Value-Based Systems.