The U.S. Dept of Health and Human Services’ Healthy People 2010,was one of the first programs to identify the elimination of health disparities as a national health goal. Rural, uninsured, and underserved populations represent three of the most significant sectors of inequality in the provision of health care in the U.S. system. Additionally, many patients in rural and underserved areas with chronic complex diseases such as HCV, substance use and mental health disorders face difficulties in accessing the specialty treatment they need. The ECHO model addresses this problem by giving physicians who specialize in treating complex and chronic conditions like HCV access to technology, enabling them to share knowledge about best practice protocols using a case-based learning approach to co-manage patients with primary caregivers in rural communities and prisons in New Mexico. Conservative estimates suggest that approximately 34,000 New Mexicans, including 2500 prisoners are infected with HCV, and the state leads the nation in deaths from chronic liver disease and cirrhosis. Prior to the launch of project ECHO, less than 1600 rural residents and no prisoners had received treatment for chronic liver disease. Since its inception in June 2004, Project ECHO has established 21 HCV treatment centers in rural New Mexico and at prisons around the state, resulting in an addition 3500 patients are receiving treatment during this time who were otherwise unlikely to have received any treatment at all. Given the success of the model to date, additional ECHO clinics have been launched for rheumatology, substance use and mental health disorders. Empowering primary caregivers at rural clinics has several long term effects. Rural physicians gain expertise, earn required continuing education credits, and are encouraged to remain in remote communities by having one of their highest priority needs answered: an opportunity to continue learning and to interact with professional colleagues.