Purpose <p>Rural surgery rotations are becoming increasingly prevalent in general surgery residency programs throughout the United States, implemented to increase interest in rural surgery practice and address access-to-care limitations in rural areas. As part of the Medical College of Georgia Rural Surgery Initiative, we implemented rural surgery rotations into our general surgery residency curriculum. This pilot study evaluates operative exposure during rural surgical rotations by quantifying ACGME case-log volume and case diversity at rural sites.</p> Methods <p>This is a single-institution retrospective descriptive pilot program analysis of ACGME case-log data from residents who completed rural surgery rotations. A focused narrative literature review of PubMed, Scopus, and Web of Science (2009–2024) was conducted using the keywords “rural surgery,” “surgical training,” and “curriculum development” to provide contextual background for interpretating the case-log findings. Case logs from four rural rotation sites were collected in February 2024 for all current general surgery residents who had completed rural rotations, N = 26. Residents at our program complete 1–2&#xa0;months at a rural site during their second, third, and fourth years of residency. A total of 47 one to two-month rotations were included in the data for comparison.</p> Results <p>Total major cases across all residents at rural sites were noted to be 2,525, with an average of 53.72 major cases per rotation. A single rural rotation contributed, on average, 6.32% to a resident’s minimum major case graduation requirement. Rural rotations also contributed significantly to residents’ endoscopy numbers. Total endoscopy cases at rural sites were 919, with an average of 19.55 per rotation. A single rural rotation contributed on average 23% to a resident’s minimum endoscopy case graduation requirement. Additionally, during a rural rotation, residents were completing 14.57% of the basic laparoscopic cases and 15.15% of the complex laparoscopic cases needed to graduate.</p> Conclusions <p>Rural surgery rotations are included in our general surgery residency program, enriching ACGME case numbers and providing a wide variety of cases in a relatively short period. This structure has offered the particular benefit of early operative experience for junior residents and endoscopy for all participating residents. These rotations provide residents with exposure to rural practice and promote networking with rural and community surgeons. Thus, these findings support rural rotations as an effective supplement to comprehensive training at the leading academic center. This pilot analysis evaluates operative exposure. It does not assess learner behavior or patient outcomes, necessitating future efforts to determine the long-term effects on resident confidence and retention in rural practice.</p>