Rouse directed Sophie Treadwell's Machinal at Brown University's Leeds Theater in 2004. Rouse was awarded the Weston Award for Fine Arts for Direction from Brown University in recognition of her work on this play. Machinal is an elegiac narrative about a young woman so oppressed by societal structures she is forced to commit an act of great violence. Reflecting the stark yet claustrophobic world of Machinal, minimal props were used, the set included no furniture of any kind, and scene transitions were choreographed such that the cast never left the stage.

One of Rouse's major innovations with Machinal was the choice to cast only nine players; seven women and two men; to play the thirty-some characters. Each actor, including the men, portrayed the main character, Helen, in one the nine scenes in the play. The gender-neutral casting brought Machinal from the 1920s to 2004 and pushed the piece to meanings beyond the proto-feminism found in the script, toward a story about individuals, who finding themselves isolated and oppressed by a mechanistic society and rigid gender construct, struggle to break free. A unique style of expressionist movement created in collaboration with contemporary dance choreographer Kyle Shepard also contributed to tell the story.

Machinal presented Rouse with an excellent opportunity to explore her interest in creating experiments combining technology with performance. To further highlight the dehumanizing nature of a society that would so brutally judge the main character, Rouse cast a life-size, remote controlled, moving and speaking robot to play the Priest in the final execution scene.