As the number of physicians and surgeons practicing in rural communities decreases the roles of those physicians must necessarily expand to meet the needs of the community. Nowhere is this more apparent than in the field of endoscopy. This analysis was undertaken to examine the role of the rural general surgeon in the performance of endoscopy and the outcomes of endoscopic procedures in the hands of the general surgeon. This is a retrospective analysis of all endoscopic procedures performed at a single institution between July 1, 1996 and December 31, 1998. Data were stratified on the basis of type of procedure, indication, and findings. The patient group was a consecutive sample of all patients during the study period referred to the single general surgeon at a small acute-care hospital in rural east-central Mississippi for endoscopic procedures. All patients met accepted criteria for the proposed procedure. Patients underwent either esophagogastroduodenoscopy, colonoscopy, or diagnostic laparoscopy. Endoscopy comprised 24 per cent of all cases performed by the surgeon. Upper endoscopy accounted for 65 per cent of the total, colonoscopy for 29 per cent, and diagnostic laparoscopy for 6 per cent. Positive findings of significance were found in 75 per cent of endoscopic cases overall. Endoscopy comprises a significant proportion of the general surgeon's practice in the rural setting. With good patient selection in this setting the positive-finding rate is very high.