Telemedicine may be useful in the delivery of clinical psychology services in the Highlands of Scotland, where geographical size and sociodemographic factors can hinder service delivery. The Highlands have a population of 210,000 at a density of approximately 8 people/km2, one of the lowest in the European Union. Despite a general lack of formal evaluation of telemedicine, especially in mental health, descriptive studies and patient satisfaction reports give grounds for optimism. There are several current applications of telemedicine in the Highlands, including cognitive-behavioural therapy, a comparative evaluation of neuropsychological assessments, and the treatment of children and their families. The projects are being formally evaluated and early results are encouraging.