Objective Pediatric treatment outcome research focusing on the physical and mental health of children living in rural areas is limited, despite the immense need. Participant recruitment is a significant barrier faced by pediatric researchers working in rural communities. The purpose of this article is to review challenges recruiting children and families to participate in treatment outcome research and identify effective and innovative procedures to enhance recruitment in rural populations. Methods A selected review of the pediatric and adult rural recruitment literature and researchers’ experiences are discussed. Results Challenges to recruitment include researchers being viewed as outsiders by rural community members, population size and density of rural communities, unique aspects of rural culture, and higher rates of poverty and lower educational achievement in rural areas. Conclusions Strategies to improve recruitment and recommendations for future recruitment efforts in pediatric psychology treatment outcome research for children and families from rural areas are provided.