Objective To understand the use of electronic health record (EHR) functionalities by physicians practicing in an underserved setting. Data Source/Study Setting A total of 333 Indian Health Service physicians (55 percent response rate) in August 2012. Study Design Cross‐sectional. Data Collection The survey assessed routine use of EHR functionalities, perceived usefulness, and barriers to adoption. Principal Findings Physicians routinely used a median 7 of 10 EHR functionalities targeted by the Meaningful Use program, but only 5 percent used all 10. Most (63 percent) felt the EHR improved quality of care. Many (76 percent) reported increased documentation time and poorer quality patient–physician interactions (45 percent). Primary care specialty and time using the EHR were positively associated with use of EHR functionalities, while perceived productivity loss was negatively associated. Conclusions Significant opportunities exist to increase use of EHR functionalities and preserve physician–patient interactions and productivity in a resource‐limited environment.