Many people with medical emergencies in rural areas would go untreated without the presence of critical access hospitals. Nurse Practitioners employed as rural healthcare providers commonly assume the roles of primary care provider in the clinic and hospitalist and emergency room provider in the critical access hospital. In a rural setting, comprehensive emergency care training is imperative as the nurse practitioner may be the sole provider on-call when a critical patient presents to the emergency room. Increased initial emergency care education and continued sustainment of rural nurse practitioners’ emergency skills is essential to the future of rural healthcare and patient safety. The purpose of this practice improvement project was to identify rural nurse practitioners’ perceived level of preparedness and competency in implementing emergency skills and develop an emergency skills seminar to increase rural nurse practitioners’ perceived level of preparedness and competency in implementing emergency skills. Secondary data analysis of the Rural Nurse Practitioner Skills Needs Assessment, previously administered to rural North Dakota nurse practitioner preceptors, was completed. Analysis of the needs assessment revealed a majority of the rural nurse practitioner preceptors felt unprepared or somewhat prepared in implementing 41 of the 51 emergency care skills within the needs assessment. Analysis of the needs assessment led to the development of the Rural Emergency Skills Seminar, providing education on three emergency skills: Procedural sedation and airway management, cervical spine management, and imminent childbirth and post-delivery care. Participants were rural North Dakota nurse practitioner preceptors and North Dakota State University Doctor of Nursing Practice students. Participants were offered a posttest to complete at the conclusion of the seminar. Comparison of the needs assessment results with seminar posttest results revealed an increased perceived level of preparedness in completing the emergency skills taught during the Rural Emergency Skills Seminar. The project served to highlight knowledge gaps in emergency care competencies and develop an educational emergency skills seminar for rural nurse practitioners.