Identifying and addressing barriers and facilitators to good patient-provider clinical interactions may enhance participation in health-promoting behaviors. We used the critical incident technique to elicit descriptions of positive and negative patient-provider interactions from both patients and providers in a rural Native American community. Using the interview data, we developed a model that illustrates the factors affecting patient-provider interactions. Trust emerged as the central theme in the determination of whether an interaction is considered good or bad. Trust was influenced by four higher-level themes: visit context, visit expectations, history, and time. These higher-level themes also affected the perceived barriers and facilitators to the clinical interaction, which were categorized as either actions or feelings/interpretations. Addressing and reducing barriers to positive clinical interactions on multiple levels is necessary for improving patient trust in the health care system, particularly among members of minority groups.