This paper paints one of many possible futures for clinical pharmacy in the year 2020, the role of the pharmacist in that scenario, and the steps required to achieve that reality. In particular, the future of clinical pharmacy in the rural setting will be offered.An emerging issues analysis of global and national trends that are driving change will be used to critique the present. This is complemented by a causal layered analysis (CLA) of problems and issues that arise in rural pharmacy practice. CLA is a tool developed by futurists to explore current issues and paradigms at several different levels of knowing. A vision of rural clinical pharmacy will be offered, using the CLA as a template. Broad strategies to guide the move from current reality to the preferred future are briefly outlined.