Introduction: Telehealth approaches have demonstrated benefits in improving positive airway pressure (PAP) compliance in patients with obstructive sleep apnea (OSA), improving access to healthcare resources, and improving health outcomes for rural communities. Methods: This quality improvement (QI) pilot study implemented weekly telemedicine visits for four weeks of PAP therapy in rural patients newly diagnosed with OSA. Epworth Sleepiness Scale (ESS) scores were compared prior to and at one month of therapy. PAP compliance was compared between rural patients who received the telemedicine intervention and a group of patients not receiving the telemedicine intervention. Results: Compliance rates were higher in the intervention group. There was not a significant difference in compliance for the intervention group (M = 63.22, SD = 32.78) versus the control group (M = 46.40, SD = 36.24), t (46) = 1.69, p = 0.099. ESS scores were significantly greater prior to one month of therapy (M = 8.38, SD = 5.70) compared to after one month of therapy (M = 2.83, SD = 2.65), t (23) = 5.22, p < 0.001, d = 1.07. Discussion: This QI pilot study utilized telemedicine to remove barriers to care, improve PAP compliance, and improve health outcomes for this underserved, rural population.