Telemedicine is a means of improving care quality and access in rural areas, but limited evidence is available on how telemedicine affects the hospital-community relationship. We examined hospital staff perceptions about the ways in which rural communities benefited from the implementation of telemedicine offered by a hub facility. We fielded 405 surveys from 84 hospitals and conducted interviews with 81 clinicians and administrators at 26 hospitals. Survey respondents had positive perceptions about the benefit of tele-emergency services to rural communities, but this finding was less true of tele-pharmacy. Interviewees described how telemedicine enhanced rural hospitals’ reputation for high-quality care, how community members benefited from being close to their support networks, and how word of positive patient experiences increased community awareness of hospital services.