Aim: To identify, describe and comment on critical health service management issues, particularly relating to human resource management, in the rural and remote context of Australia. Approach: A case study of a Remote Area Nurse manager. Context: Very remote Australia is characterised by ongoing workforce supply problems, professional, social and geographical isolation of practitioners, relatively scarce health resources, a dispersed and highly mobile population and high morbidity and mortality rates. Many practitioners work in a cross-cultural environment. Main findings: This case was characterised by generally poor Human Resources (HR) practice. We assert that this resulted from a (1) relatively under-funded environment; (2) resultant poor systems relating to orientation and induction of new staff, communication with remote clinics, quality improvement and pastoral care; (3) a centralised health system structure not well suited to a primary health care approach to a dispersed population; and (4) inadequate preparation of operational managers, associated with inadequate recognition of health services management as a health discipline and related continuing professional development and accreditation requirements. Conclusion: Given continuing national and international health workforce pressures, the generalisability of these issues needs to be better determined and appropriate policy changes urgently implemented.