Background: General surgeons form a crucial component of the medical workforce in rural areas of the United States. Any decline in their numbers could have profound effects on access to adequate health care in such areas. Aim: To determine the numbers, characteristics, and distribution of general surgeons currently practicing in the rural United States. Methods: The American Medical Association’s Physician Masterfile was used to identify all clinically active general surgeons as well as their location and characteristics. Their geographic distribution was examined using the ZIP code version of the Rural-Urban Commuting Areas (RUCAs). Results: Nationally, the number of general surgeons per 100,000 population varies from 6.53 in urban areas to 7.71 in large rural areas and 4.67 in small/isolated rural areas. Only 10.6% of the nation’s general surgeons were female. General surgeons in the smallest rural areas were more likely than those in urban areas to be male (92.7% versus 88.3%), 50 years of age or older (51.6% versus 42.1%), or international medical graduates (25.2% versus 20.1%). Conclusions: The overall size of the rural general surgical workforce has remained static, but its demographic characteristics suggest that numbers will decline. Many rural residents have limited access to surgical services. This project was funded by HRSA’s FORHP, with the publication Thompson et al. 2005 and Final Report #77 as deliverables.