The intent of this paper is to identify and provide insight on key enablers for successful implementation of telehealth services in severely under-resourced and rural populations. The case study presented is in the context of the U.S. Affiliated Pacific Islands that represent resilient and innovative communities who face many challenges of isolation, tiny populations, and developing economies. Long-standing telecommunication hindrances and lack of supporting resources are fundamental barriers to telehealth advancement. New undersea fiber optic developments present opportunities for reliable connectivity needed for telehealth applications. This paper reviews the emergence of telehealth champions in the region and reviews key elements that contribute to rapid and successful implementation of telehealth applications and services.