Introduction. Medical-legal partnerships perform advocacy services for vulnerable and underserved populations, who are burdened disproportionately by legal and medical problems. This study aimed to examine the effectiveness and projected sustainability of a rural medical-legal partnership (MLP). Methods. Five years of baseline data and three years of follow-up data were analyzed using descriptive and inferential statistics as well as logic modeling. Results. The benefit relative to cost of the MLP increased between the years of 2002-2006 and 2007-2009. The number of people served increased across the two time periods, and the proportion of cases won remained the same. Overall, the population served remained similar across time. The MLP continued to show social and financial impacts, such as health care recovery dollars (319% return on investment between 2007 and 2009), Social Security benefits, family law services, and end-of-life guidance. Conclusion. A rural MLP can maintain its impact and efficiency across time and have opportunities for expansion.