Failure to retain health professionals in rural areas contributes to the poor health status of these communities through an inability to deliver reliable and consistent services. Considerable attention has focused on factors affecting recruitment of health professionals. Far less is known about factors affecting the retention of occupational therapists. In this study ethnographic interviews were conducted with 10 occupational therapists to explore their experiences related to leaving rural practice. Six themes emerged from the participants' experiences and gave rise to a framework that suggests retention can be improved by addressing the imbalance between incentives to leave and to stay in rural practice. The findings can be used by occupational therapists contemplating rural practice, as well as by health services managers responsible for service delivery in rural areas.