This study surveyed chief executive officers (CEOs) of 29 small and rural hospitals (with a median of 28 staffed hospital beds) to determine their priorities for improving patient safety, and compared them with the recommendations of an expert panel. While both CEOs and the expert panel agreed that preventing adverse drug events (ADEs), preventing nosocomial infections, and improving the safety culture were important, they disagreed on the methods of achieving these goals. For example, rural hospitals placed less emphasis on the need for sophisticated information technology to prevent ADEs. These differences were at least in part due to rural hospitals' concerns about their ability to implement recommended interventions.