Dementia Special Care Units (SCUs) are more likely to be found in larger nursing homes, which tend to be located in urban centres, rather than in smaller rural nursing homes. Reasons for the small number of rural SCUs are not known, although it has been speculated that space and staffing constraints, lack of a critical mass of residents needing specialized care and limited resources may be important factors. The purpose of this study was to describe the development of SCUs in eight small rural nursing homes (31-100 beds) in Saskatchewan, Canada, from the perspective of nursing directors involved in planning and implementing the units. Although the initial focus was on how and why the SCUs were established, the key finding was the critical role of nursing leadership and supervision in creating and sustaining the unit. Even the most successful SCUs required constant vigilance to maintain an effective program, highlighting their inherent fragility and the need for a designated, committed leader. Four key leadership activities were identified: perpetual reinforcement and enforcement of SCU goals and ideals; support, guidance and mentoring of staff; empowerment of staff; and liaison/public relations.