Cancer genetic counseling (CGC) has become standard of care for individuals at increased risk of hereditary cancer. However, because access to CGC is limited in rural communities, several groups are underserved by CGC, and little knowledge exists about characteristics and decisions of individuals who have CGC in a rural setting. We describe pilot data from an outreach CGC program from the Duke Hereditary Cancer Clinic to six rural North Carolina oncology clinics. We assessed whether the program was successfully established and whether outreach patients' characteristics differed from those of patients seen in the tertiary care center. Between February 2005 and February 2006, genetic counseling was provided to 57 patients in the outreach clinics and 275 patients in the tertiary care clinic. We found the program reached individuals less likely to receive CGC otherwise and that patients were satisfied with it. Differences found between outreach and tertiary care patients in race, insurance type, risk of having a hereditary cancer syndrome, and genetic testing decision highlight the importance of continued research to characterize rural CGC patients and understand their decisions.