Recent calls for increased palliative care education of physicians and a need to improve the effectiveness of palliative care delivery in rural areas are the stimuli for this study. The needs assessment evaluated educational needs and preferences of physicians practicing in three Regional Health Authorities in southern Manitoba in 2000, as well as semi-structured interviews with health care workers in seven rural communities. Physicians report their knowledge of symptom management issues as adequate, although for other issues in palliative care such as bereavement, psychosocial aspects of dying, and professional issues, they have less confidence. Physicians prefer learning through case studies, lectures, and self-directed learning, in settings close to their community, on the weekend. Qualitative analysis from the semi-structured interviews revealed themes related to the role of physicians in rural palliative care: i) a need for physician education, ii) physician participation within the palliative care team, and iii) physician involvement in patient-centered care.