Children living in rural areas encounter unique, significant barriers to the receipt of health care, including pediatric specialty care. In this article, the authors review these barriers and evaluate the advantages and limitations of various access tools intended to better connect children to specialty care. They highlight the potential of some access tools to increase rural primary care physicians’ skill and involvement in their patient care, but also the risks of increasing rural primary care providers’ workload and responsibilities without increasing their resources. They contextualize these benefits and risks within the quintuple aims advanced by the Institute of Healthcare Improvement.