A library should review carefully the complex implications before undertaking to be a Regional Medical Library. Eight important considerations are examined: Possible conflict of interest between local, defined clientele and larger regional clientele; Indirect costs, especially as they relate to administrative and management time; Possible abuse of unlimited cost-free copy service; Region-wide participation in planning efforts; The hazard of depressing the quality of the rank and file of local libraries; Balance between private and public support--the risk of diminished dues support for library extension services; Complexities of territory definition; and Defining the proper recipient (the "qualified individual") of regional library service. Recognition of the problems should not be interpreted as a lack of appreciation of the great opportunity which the regional program affords.