Persons living in rural counties often have limited access to health care. From a random sample, 1,332 households in six rural western New York counties were interviewed by telephone to identify what health care facilities are used when seeking professional health care what factors affect the preference for a health care facility and whether individuals perceive a shortage of health services in their communities. Seventy-nine percent of rural western New York individuals surveyed visited a physician between June 1988 and January 1990. The majority (83%) of individuals visited their regular health care source, which in most cases (81%) was a physician's private office. Factors related to a preference for some other health care source for the last visit included having traveled 20 or more miles to the visit (p < 0.01) and lack of overall satisfaction with the last visit (p < 0.001). Factors that varied by county of residency and were significantly associated with satisfaction included the type of health source used (p < 0.001), and the distance traveled to the last health care visit (p < 0.01). The majority of the respondents did not perceive a shortage of health care services in their communities probably because they have a lower expectation of health care accessibility.