Many women in remote regions of Africa face a day’s journey to the nearest hospital if they need emergency obstetrics care. In the US, millions are cut off from vital specialty services, not only because of geography but because of economic circumstance, immigrant status, and clinical shortages. How can the system deliver healthcare more efficiently in remote or resource-poor settings? What best-practice options can be replicated, from e-training and video mentoring to the use of non-physician clinicians and portable, battery-operated equipment? Peter Drobac, Shawn Duran, Raj Panjabi, Jacques Sebisaho, Sarika Bansal