Abstract Background Preparation of future general surgeons requires the ongoing assessment of projected case experience. Methods Surgical procedures (2005–2008) were abstracted from the Centers for Medicare and Medicaid Services inpatient National Claims History Part A 100% Nearline File for all general surgeons. The most frequent Medicare surgical procedures and physician caseloads were compared by practice population. Results Over 5 million procedures were evaluated, with procedures decreasing over time in urban and large rural areas. A total of 15 procedures comprised the top 10 for all population/year categories. The most frequent surgical procedures were similar in rural and urban areas. Rural surgeons' caseloads consisted of a higher proportion of endoscopic procedures. Conclusions The most common Medicare general surgery procedures are similar across population areas and are required experience for residents. Separate surgical educational programs for urban and rural general surgeons may not be necessary to provide adequate care to rural patients.