Our study explored ambulatory practice differences between rural and urban primary care physicians. Because most rural practitioners are not educated through special rural tracks, all primary care medical educators need to ensure that training prepares physicians for the demands of rural sites. Visits to family, general practice, internal medicine, and pediatric physicians from the 1996 and 1997 National Ambulatory Medical Care Surveys were analyzed. "Rural" was defined as outside a metropolitan statistical area. Family physicians handled the majority of rural visits, even among pediatric populations. Acute injuries represented 6.1% of rural visits versus 5.0% of urban visits. Conditions likely to be associated with pain (degenerative joint disease, low-back pain, myalgias, headaches, and bursitis) were higher among rural visits (8.5% versus 5.4% urban). Preventive counseling and services and anticipatory guidance for children were provided less frequently in rural visits. Physicians entering rural primary care practice need training in acute injury and chronic pain syndromes, as well as ample exposure to care for children. Research is needed to explain the less-frequent provision of clinical preventive services in rural areas. Given clinical similarities between rural and urban visit content, subtle differences in provision of acute care and preventive services may provide important clues to training needs among physicians preparing to enter rural practice.