A challenge facing the Faculty of Health Sciences, University of Cape Town, South Africa, is to compete with universities around the world, while dealing with developing countries' obstacles. In the second year of the medical curriculum, Anatomical Pathology plays a crucial role, and the shortage of trained staff threatened to damage the quality of education. Although Information Technology (IT) could be used to solve the problem, this would need to be performed within the restraints of available resources within a substantially poorer IT environment than is found in developed countries. This paper describes the processes involved in using the online teaching environment, WebCT, to resolve these problems. We detail the assumptions and decisions we made about students, resources, and choices regarding approaches and methods of content delivery. In addition, we describe the student usage patterns, evaluations, refinements, successes and failures. Finally, we end with the new knowledge that has taken us into the next year of implementation.