To expand access to mental health treatment in an underserved area, the University of Washington and Dayton General Hospital (DGH) entered into a partnership in 2018 to provide comprehensive telepsychiatry services to individuals living in rural Columbia County, population 4000. Dayton General Hospital is a “Critical Access Hospital,” which is a federal designation denoting facility that have fewer than 25 beds and are more than 35 miles from the next hospital but provide 24/7 emergency services. DGH is also affiliated with two primary care clinics and a nursing home. The telepsychiatry program provides a comprehensive range of services, including outpatient integrated care, nursing home psychotropic case reviews, general inpatient consults, inpatient and outpatient addictions consults, and psychiatric representation in multidisciplinary treatment team meetings. Outpatient services are delivered via a collaborative care model at two DGH-affiliated primary care clinics in consultation with Matt Iles-Shih, MD, MPH, a Harborview Medical Center-based psychiatrist who has additional expertise in addictions. Inpatient consults at DGH are supported by Mike Huijon, MD, and Tom Soeprono, MD, two UWMC-based, consultation-liaison psychiatrists. Patients participate in videoconferencing sessions, directly from their hospital bed at DGH or exam room at the primary care clinic, with Seattle-based, UW psychiatrists.