Access to the appropriate healthcare in a rural area is very challenging. Especially, residents in a rural area may not be able to receive an appropriate cardiology care. Especially, heart failure is one of the most common disease states in the cardiology field. Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) showed mortality benefits but pharmacotherapy for residents in rural areas may be suboptimal due to lack of access to cardiology care. Although multiple studies revealed that the maximum tolerated dose of GDMT was associated with better clinical outcomes than low dose, real-world studies showed that GDMT use and dose were currently sub-optimized in real-world settings. Ambulatory care pharmacists in rural areas could play a pivotal role in optimizing pharmacotherapy for patients with HFrEF. The author will present four major heart failure care issues that ambulatory care pharmacists in rural care could improve: 1. Heart failure GDMT use and dose suboptimization 2. The use of medications that could worsen heart failure3. GDMT sub-optimal adherence rate 4. Lack of patients' understanding of non-pharmacological therapy for heart failure care