Surgeon availability is a problem for small and isolated rural areas. Unless the supply of surgeons trained for rural areas increases, patient care will be jeopardized. Nationally, a diminishing number of graduating residents opt for careers in general surgery. This crisis is unrecognized or ignored by major teaching programs. This article describes a program at the University of North Dakota that allows exposure to surgical specialties by incorporating them into the general surgical services. It concludes that distinct training for urban and rural general surgeons must be recognized; and general surgery programs should be allowed to be innovative and not penalized for adjusting their programs to allow residents to train for rural and community sites.