Purpose: Nursing in a rural emergency department is a physically and emotionally demanding job. The challenges of working under these conditions can be very stressful for nurses. Work place stress can result in nurses developing mental health issues with subsequent physical consequences. These mental health issues, when experienced by nurses, can compromise patient care and safety. The consequences of work related mental health challenges are not isolated to the workplace but also have the potential to disrupt and destroy nurses’ careers and family life. This article addresses the following research question: What are the experiences of rural emergency nurses that can contribute to, or leave rural emergency nurses vulnerable to, the development of work related mental health issues. Sample Participants were emergency department registered nursing staff from one hospital located in a rural community north of Toronto.Method: An exploratory qualitative descriptive study design was chosen, in which rural emergency department nurses were invited to share their stories through face-to-face in-depth interviews.Findings: Rural emergency nurses are challenged by a lack of resources, anxious about working outside their scope of practice, and are concerned about issues related to patient privacy and their own anonymity in the community. Added to this is the emotional impact of caring for young trauma patients, family, and people they know from the community. These experiences also affect their family members and can be expressed by lashing out, impatience, and withdrawing from interactions with them.Conclusion: Workplace challenges faced by rural emergency nurses can contribute to occupational mental health issues such as compassion fatigue and burnout. Managers of rural emergency departments need to acknowledge the unique working conditions of the nurses, improve communication, and tailor support programs to meet the needs of each individual nurse who has experienced an occupational threat to their mental well-being.Keywords: Rural Emergency Nurses, Mental Health, Compassion Fatigue, Stress, Burnout, Occupational HealthDOI: http://dx.doi.org/10.14574/ojrnhc.v19i2.550