Many rural health care facilities are financially strained and in danger of closing. One reason is that some patients bypass their local facilities and travel longer distances to urban medical centers for care. We surveyed the residents of two rural Minnesota communities to investigate the factors that draw rural residents to larger urban medical centers. Patient perceptions that bigger is better and that smaller, rural medical facilities are unable to keep up with technology appear to be at the heart of the issue. We asked about residents' attitudes and perceptions of their local health care systems as compared with an urban system. Most rural residents perceive rural primary care physicians as more compassionate and accessible than their urban colleagues; however, many feel rural physicians are less qualified.