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This case describes the evolution of Rural Health Care Foundation (RHCF), which provides primary healthcare services to the economically underprivileged in rural India, its various alliances with non-governmental organizations (NGOs) and for-profit organizations. RHCF centers attract large number of patients every day from as far away as 100 km, due to low charges (INR40, which is less than USD1, for consultation and a week's supply of medicine) and availability of reliable doctors. The case discusses the scale up challenges RHCF is facing to expand their centers to other locations as well as to provide other services within each center. The case also highlights the role various alliances, between NGOs and for profit organizations, play in delivering healthcare services to the bottom of the pyramid, especially those living in rural localities and can neither access nor afford proper medical facilities.