Children are deserving targets of healthcare policy. However, to make a difference to children's lives, health and welfare policy goals have to be translated into services. For children and families living in small Australian rural communities, access to assistance and support from health services is dependent on the administrative and technical detail of health policy. This paper reports the findings of a case study investigating health care in two small rural towns in New South Wales. The study takes a pragmatic and practical approach to identifying the impact of policy intent on improving the health of rural children. The study identified the way policy goals are translated into practice by interviewing three distinct groups; policy makers, policy implementers and policy recipients. The research found that health policy was not well costed, implemented or available to children who lived outside regional or metropolitan areas. There were limited avenues for children, parents or health workers to influence the policy development or implementation process. © 2010 Nova Science Publishers, Inc. All rights reserved.