Pennsylvania has seven counties classified as 100% rural according to 1990 census data. The author surveyed all of the registered physicians living in these seven counties with regard to their self-reports of participation in, and preference for, CME activities as they relate to their methods of keeping up to date with innovation and new knowledge. Thirty-eight usable responses were received with a response rate of 42% from all potentially active physicians (91) in the study area. Respondents indicated that the least used types of CME focused on educational methods generally associated with self-paced learning. These methods included video or audio CME, self-assessment programs, and computerized activities. From the findings, two important conclusions were reached. First, this group of physicians exhibited symptoms of distance impairment, the real or imagined condition of geographic isolation experienced by the learner, which contributes to an unwillingness, or inability, to bridge a gap in distance between an educational resource and a personal, educational need or desire. Second, the physicians displayed a lack of desire, or possibly a lack of skill, to participate in various methods of self-directed learning.