The purpose of this paper is to understand current employee voice arrangements within a semi‐rural hospital and the implications for the engagement of healthcare professionals. The Job Demands‐Resources (JDR) model is used to explore how organisational mechanisms (resourcing, decision‐making processes and culture) provide a voice for staff. We adopt a single case study approach using in‐depth interviews with healthcare professionals in a semi‐rural public hospital in Australia. The study found that the semi‐rural context, characterised by high levels of centralised decision‐making and resourcing and low levels of confidentiality and anonymity, has limited employee voice and the ability for staff to participate in decisions affecting their work. This lack of voice has consequently had negative effects on engagement levels. We propose that employee voice be viewed as a distinct job resource, manifest through an organisation’s resourcing, decision‐making processes and culture, to generate a direct and positive effect on employee engagement.