A two-stage nationwide mail survey of U.S. medical school graduates of the class of 1965 was conducted to identify physician location decision factors that seem to differentiate physicians who choose a rural practice location from those who choose an urban one. Although the response data are undergoing further analysis, some conclusions are clear. The rural-reared physician is three times as likely to choose a rural practice as an urban-reared physician. Climate and geographic considerations seem the most pervasive of stated decision influences for both rural and urban physicians. Professional considerations, such as the opportunity for regular contact with a medical center and the clinical and peer support and access to continuing education that it allows, appear to be important to physicians who choose to locate in urban areas. In fact, responses from urban physicians who seriously considered rural practice attest to the professional concerns of many who have not closed their minds to rural practice.