Strong and healthy relationships play a vital role in building the ongoing health and wellbeing of individuals, families and the broader community. With increasing pressure on the traditional social support mechanisms of extended family, friends and neighbours, particularly in non-urban regions, there is a growing need for professional family and relationship services. However, there is limited robust evidence about what makes these services effective, especially when delivered in rural, regional or remote settings. This paper briefly reviews recent demographic, social and economic trends in rural, regional and remote Australia in order to provide the contextual background to service delivery in the region. A number of enablers and limiting factors for effective rural service delivery are outlined. These factors are based on a review of the limited evidence base on family and relationships service delivery and the broader literature on service delivery to rural settings. Considerable emphasis is given to workforce issues as a way of addressing service sustainability.