The purpose of this study was to compare the epidemiology of musculoskeletal injuries and workplace ergonomics among rural-based sonographers compared to urban-based sonographers. The authors also tested the use of a biomechanical software program to assess load on the spine and upper extremity joints. A mail-in survey was sent to all practicing sonographers in rural Manitoba, and on-site video-taped ergonomic and biomechanical evaluations were completed for four sites. Rural-based sonographers appear to have greater work stress related to waiting lists, use of outdated and non-adjustable equipment, and high client load. They also do not advocate for better working conditions because they are few in number and geographically distant from one another. Use of the biomechanical software proved minimally useful. Information related to industry standards and greater collaboration is needed to promote workplace health for sonographers.