General surgeons have an essential role in the rural health care system. This telephone survey of 39 rural general surgeons in Missouri found that more than half were 55 or older. Most reported they practiced a broader scope of surgery than colleagues in urban areas, and half believed that current residency graduates are not prepared for surgical practice in rural areas. One-fifth had sought special training experiences to prepare them for rural practice. On balance, 70 percent of the respondents' practices was general surgery, 13 percent "specialty surgery" and 17 percent primary care. Many reported feeling professionally isolated. One-fourth had literally "returned home" to practice. The results suggest that if present trends continue, the next 10 years will see a substantial reduction in the number of general surgeons in rural Missouri.