This paper demonstrates how undertaking a Health Impact Assessment (HIA) assists in considering the likely impacts of a proposed reconfiguration in the model of health service delivery to a small rural community.  The proposed service changes are being considered in response to the ongoing issues of sustainability and access to health services in small rural communities, especially with regard to addressing the challenges of recruitment and retention of health staff and identifying the needs of ageing and decreasing populations.  Redesign of health service delivery and the consequent impacts on service quality, ability to access services, availability of services and workforce all need to be considered.