This article describes the development of an innovative approach to case management for rural clients in drug abuse treatment. This innovative approach is discussed in the context of the broader field of case management-including social casework, public health, nursing, modern case management, and managed care. Because case management has been defined in many different ways, making comparisons of programs and models is difficult. The article presents an expanded set of criteria for comparing case management models. The Iowa Case Management model is compared with these other models across several dimensions. This article also describes the philosophy and goals of the Iowa model, as well as key activities in which clients and case managers participate. The authors discuss implications for practice and issues related to evaluation of case management.