This article describes the unique roles and interrelations of general surgeons and primary care physicians in rural communities. It describes the various ways in which the work and success of the rural surgeon and the rural primary care physician rely on coordinating their efforts with the other. It draws on available data, summary reports, and the authors’ personal experiences in rural practice and fifty years of combined experience in research and policy analysis of rural health professions issues. Various issues are discussed, including the specific and unique roles that rural surgeon need to play in rural health systems, the ways in which rural surgeons relate to other physicians, and the likely consequences of not having proximal surgical services.