Community paramedicine is a quickly evolving field in both rural and urban areas as Emergency Medical Services (EMS) providers look to reduce the use of EMS services for non-emergent 911 calls, overcrowding of emergency departments, and healthcare costs. In rural areas, community paramedics help fill gaps in the local delivery system due to shortages of primary care physicians and long travel times to the nearest hospital or clinic. This study examined the evidence base for community paramedicine in rural communities, the role of community paramedics in rural healthcare delivery systems, the challenges faced by states in implementing community paramedicine programs, and the role of the state Flex programs in supporting development of community paramedicine programs. Additionally, this briefing paper provides a snapshot of community paramedicine programs currently being developed and/or implemented in rural areas. Another FMT policy brief summarizes these same findings.