Background <p>To address imbalances in the distribution of refugees and asylum-seekers during resettlement in high-income countries, some governments are employing dispersal strategies to extend resettlement beyond major cities. However, with populations in non-metropolitan areas facing well-documented differences in healthcare access and outcomes compared to their city counterparts, it is essential to consider the human impact of these resettlement policies. The primary aim of this study was to understand the healthcare experiences of refugees and asylum-seekers living in rural, regional, and other non-metropolitan areas of high-income countries. The secondary aim was to identify factors that influence these experiences.</p> Methods <p>A thematic synthesis of qualitative or mixed-methods studies was undertaken. We searched seven electronic databases, Medline(OvidSP), Embase(OvidSP), PsycINFO(OvidSP), CINAHL(EBSCOHost), Social Science Citation Index(Web of Science Core Collection), BIOSIS Citation Index(Web of Science) and ASSIA(Proquest), up to October 6, 2025, for articles in English reporting qualitative data on the healthcare experiences of refugees and asylum seekers. At least two reviewers contributed to all review stages, including quality assessment.</p> Results <p>Seventeen articles representing fourteen studies were included, capturing the experiences of 347 refugees and asylum-seekers. We developed descriptive themes characterising everyday healthcare experiences, from which analytical themes were produced to describe underlying determinants of these experiences: <i>The Domains of Influence, The Power of the Social, and The Rural Effect</i>. These findings explain how the convergence of a refugee or asylum-seeker’s individual, sociocultural, environmental, and political realities shape their healthcare experiences after resettlement in a rural area. They highlight how rurality and place interact with social and structural determinants of health to intensify both the supportive dimensions of small-community life and the barriers and inequities produced by limited resources, distance, and geographic isolation.</p> Conclusions <p>Despite policies promoting non-metropolitan resettlement in high-income countries, research on the healthcare experiences of refugees and asylum seekers in these areas remains limited. This review both characterises these experiences and suggests factors that shape them, which can inform healthcare providers and policymakers in addressing health inequities.</p> Registration <p>PROSPERO CRD42024553190.</p>