Point-of-care ultrasound has expanded rapidly into new applications in limited-resource settings as ultrasound machines become more portable, affordable, and accessible. These settings include, but are not limited to, global, rural, and other remote areas such as space, cruise ships/long voyage vessels, and wilderness environments. This chapter identifies specific issues surrounding ultrasound program development in these environments as well as key areas of focus to guide successful implementation. Each area has unique considerations but many overlapping concepts such as proper durable equipment, creation of an in-depth needs assessment, a hybrid educational model, stakeholder engagement and interdisciplinary collaboration, and a platform for image storage and quality assurance, among others. As these austere settings continue to expand their use of ultrasound, reliance on technologies such as tele-guidance and artificial intelligence will become paramount for their future growth.