Chronic disease prevalence is increasing worldwide, and patients in rural areas experience an increased burden of chronic disease. Increasing penetration of the Internet into rural and remote areas has enabled the delivery of online chronic disease management (CDM) interventions. This review aimed to examine the effectiveness and uptake of online CDM interventions among rural populations with existing chronic disease. A total of 13 studies met the inclusion criteria; these were categorized into web-based self-management interventions (N = 3), interactive online groups (N = 6), and provider-mediated online interventions (N = 4). Those studies with stronger designs showed evidence that online CDM interventions were effective in increasing health-related knowledge and psychosocial adaptation among rural patients with existing chronic disease. User acceptance among rural patients with chronic disease was related to time demands, Internet access, and confidence with technology, but overall satisfactory retention rates show promise for further development and implementation. There is a need for further rigorous trials among rural populations.