People in rural health are passionate about making a difference. Clinicians endeavour to optimise the health of every person they work with, managers seek to maximise team efficiency, executives and directors strive to have services working effectively. These efforts are guided and supported by those who plan, measure, report, analyse, and those who develop clinical guidelines and health policy. Each of these activities has an impact. The activity might impact just one person's quality of life. This is important in itself, but usually the impact of what we do reverberates across family, friends, networks, other services and communities.