The results are reported from a mail survey to a 25 percent sample of all allopathic and osteopathic physicians practicing in countries less than 10,000 population in 1988. Overall, 71 percent of respondents indicated that they were satisfied with their practice in those areas but 23 percent indicated dissatisfaction and 26 percent planned to leave those areas within five years. Factors associated with practice dissatisfaction included lower income, long hours worked, increase in patients with inadequate medical insurance and distance from a major referral center. Thirty-two percent of respondents indicated that there were too few physicians in their counties and in aggregate projected a need for 1,100 additional physicians, or approximately a 50 percent increase relative to the current supply of physicians in such counties. Seventy-four percent of those indicating a need for more physicians stated that in their opinion the community in which they were practicing could support such additions. The survey results indicate an underlying satisfaction with rural practice but suggest the need for ongoing educational and financial incentives for such practices if the delivery of health care services in rural areas is to be improved.