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This thesis examined specific issues dealing with the use of telemental health in pastoral counseling. From this research two conclusions can be drawn. The forty-two Minnesota town and country churches in the study group are technologically ready for telemental health; however, the human aspect of using telemental health is lagging behind the technology. 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Socio-cultural misunderstanding hampers relational harmony and ministry effectiveness in affected churches. In response to this problem, the researcher surveyed rurban leaders in three geographic regions of the United States, identified the major recurrent components of the rurban collision, and made recommendations to church leaders concerning how to effectively lead in the presence of rurban socio-cultural tension. 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