Abstract: Development and growth of a rural Veterans Affairs Medical Center (VAMC) research program is one way to provide best care. This article reports the steps and barriers to building a rural research centre, using examples from western North Carolina. One goal driving the research centre’s creation was to increase under-served communities in the research workforce and among participants enrolled in Veterans Health Administration (VHA) research. The VHA reports health care differences for 4.7 million rural and highly rural Veterans, with rural Veterans using VHA services differently than urban and suburban Veterans. A total of 58% of rural Veterans enroll in the VHA, compared with 37% of urban and suburban Veterans. To achieve optimal Veteran health, all Veteran sub-groups must be adequately represented in clinical research trials, but rural Veterans are currently not equally represented. Research centre development steps included: 1) hiring a program specialist to focus on developmental needs, 2) finding a local program assistant to address the details required to develop a research centre, 3) obtaining a designated regulatory staff member, 4) negotiating staff, space, and focus needs, 5) hiring an experienced researcher to support initial research efforts, and 6) networking with other VAMCs, hospitals, agencies, and universities to create a best-care community. This article outlines the development and growth of a rural Veterans Affairs Medical Center (VAMC) research program in western North Carolina, United States, and highlights approaches to staffing, funding, and networking. Building a viable research program is one means to improve rural Veteran clinical trial inclusion rates, reduce trial participant disparity, and optimally inform best-practice clinical care guidelines. Defining and creating a small VAMC research program requires diligence and unique solutions, including overcoming hiring hurdles, building collaborations across Veterans Affairs facilities, industry, and community, and carefully crafting development phases via communication, networking, and education to ensure a good fit at each step to solidify continued growth.