Functioning healthcare systems provide emergency medical care. Disparities exist in accessibility and availability of emergency care in low- and middle-income countries. We present a descriptive epidemiologic analysis of Emergency Department (ED) usage in a rural, indigenous Guatemalan population. San Lucas Tolimán is situated in central Guatemala. Hospital Parroquial de San Lucas offers emergency care to San Lucas Tolimán and surrounding villages. All ED visits between January 1st, 2016 and December 31st 2018 were recorded and analyzed. During the study period, 12,229 patient encounters occurred. Almost all patients identified as indigenous. Children comprised 43% of visits. Medical issues represented a majority (83%) of complaints. Respiratory (40%) and gastrointestinal disease (26%) were frequent presenting complaints. Almost all visits (83%) occurred during the day and evening hours. Trauma/surgical complaints were slightly more frequent at night. 93% of patients were discharged, while the rest were admitted or transferred. These data contribute to understanding of disease burden and emergency care needs and capacity in rural areas of low- and middle-income countries. This information may be used to inform local policy decisions, identify research priorities, and create training topics for local health care providers in Guatemala and other countries in this region.