Policy suggests that health service providers should plan services with communities. In remote and rural areas this is sometimes ineffective, resulting in resistance to change. An action research project investigated best practise in rural community engagement. As a result a planning 'game' was developed that uses a number of types and levels of cards and allows community members, as part of a process of engagement, to express their priorities and designs in a form that is directly usable by health service managers. The game is a unique community engagement resource in that it combines the priorities of the community (including their experiences of using services) with existing service data. It allows community members and service managers to apply their priorities for services to a healthcare budget to identify appropriate and affordable ways of providing safe local services.