Various issues confront Japan's elderly population, particularly in rural areas. These issues need to be examined to fully understand the dynamics of the provision of health care. Only by understanding the different components and their impact on patient care can improvements be made to the delivery of services and ultimately the quality of care. In this review, a consideration of different aspects of care is undertaken, with a focus on rural areas. Potentials for improvements are also discussed. Electronic databases such as CiNii and ICHUSHI searched by Japanese and PubMed and CINAHL searched by English were searched to retrieve peer-reviewed primary research literature. A narrative synthesis of the findings sections of the papers was applied to identify key themes. These themes consider the range of issues affecting health care in rural Japan: Service delivery, distribution, resources, health care, rural and elderly. In total, eight papers with either qualitative or quantitative methodology were included in the review. The review highlights a broad range of issues being confronted, most of them likely to have a medium to long term impact on the quality of care in Japanese rural areas. Government, community and professional carers' attention to these issues is thus critical to ensuring improved health care to reassure a high quality of life for elderly in rural areas in Japan.