Walk into the pharmacy on Main Street in the east-central Iowa town of Brooklyn, and it looks like any other small-town pharmacy — cold and flu remedies on the shelves, birthday cards for sale and two friendly pharmacy technicians working behind the counter.

Yet what makes the Brooklyn Pharmacy unique is what’s missing: the pharmacist.

An off-site pharmacist approves all the prescriptions before distribution using teleconferencing technology and consults one-on-one with patients on a touchscreen if they have any questions.

The Brooklyn Pharmacy is part of a state pilot project to test a new generation of telepharmacies in rural Iowa.

The Iowa City-based company Telepharm helped launch the pilot project in a handful of eastern Iowa communities in 2012 to demonstrate how its software could help bring pharmacies back to rural towns.

Over the years, many rural pharmacies have closed their doors as they struggle with a declining population and competition from grocery and big-box pharmacies down the road.

Without a pharmacy in town, rural Iowans often must drive 20 miles or more just to refill a much-needed prescription.

Filling a...