Context: “If there is two-tiered medicine in Canada, it’s not rich and poor, it’s urban versus rural.” – Dr. John Wooten, past-president of the Society of Rural Physicians of Canada. For the 6 million Canadians living in rural areas, emergency services are a critical safety net and a hub for primary care. Nevertheless, the urban-dominant model that underlies most primary care improvement initiatives in Canada neglects the particularities of rural settings. The rural Living Lab at Baie-Saint-Paul hospital (Québec, Canada) was designed to co-develop, with local stakeholders, sustainable and scalable solutions to the problems of emergency and primary care in rural areas and to implement, evaluate and transfer them elsewhere. A governance structure will be defined and established and the Lab will start with 3 pilot projects: 1) telemedicine; 2) deployment of medical residents’ in the pandemic context; 3) CT scan implementation. Objectives: To present key issues (barriers, facilitators, actor’s role and satisfaction, etc.) that have arisen during these early stages of implementation of the Living Lab. Study Design: Mixed-method case study. Setting: Built in 2018, Baie-Saint-Paul Hospital is a state-of-the-art facility 95 km from Quebec City. The ED receives an average of 13,500 visits per year. Population Studied: The Lab is an experimental milieu where patients, community representatives, decision makers, researchers, healthcare professionals and other stakeholders collaborate at every stage of a variety of locally-conceived projects. All participants are included in this study (approx. 50 persons). Preliminary evaluation data from project logbooks, interviews, participant observation, project documents and questionnaires will be extracted and analyzed. Outcome Measures: Primary outcome: extent to which the 3 pilots projects have been co-designed, implemented, evaluated and transferred. Secondary outcomes: levels of satisfaction of key actors, barriers and facilitating factors. Both successes and failures will be noted and learned from. Anticipated Results: Key issues that arose during the early stages of the implementation of Baie-Saint-Paul Hospital Living Lab will be of great interest to inform the future of this unique participative project. Ultimately, the Baie-Saint-Paul Hospital Living Lab will contribute to improve primary care and services in this hospital and in other rural facilities.