For many years researchers have been concerned about the alignment of Information Technology (IT) in businesses. Most of the published research has been focused on understanding the alignment of IT with strategy, but a more recent view is that IT alignment with processes would be better, especially for SMEs. This research presents the two different approaches to measuring IT alignment, then uses the case of a small dental clinic to contribute to understanding these two alternative approaches. The results showed that both strategic alignment and process alignment were important, but strategic guidelines set the framework for the use of IT in the processes. These results contradict the claims of researchers who defend the process approach. This work has implications for practitioners because it again highlights the importance of IT in a strategic context in SMEs. This research also contributes to the theory of IT alignment in SMEs, and we hope this will encourage other researchers to study which approach is best suited for this type of business.