Rural areas in South Korea lack adequate healthcare facilities, and many older people wish to continue living in their current environment despite these challenges. This study derives a substantive theory on the aging-in-place process among older people living alone with chronic diseases in rural areas. Purposeful and theoretical sampling were used to select 18 participants. In-depth interviews were conducted over 3 months, and data were analyzed using Strauss and Corbin's grounded theory method. Twelve categories and 28 subcategories were identified, with the core category being "enduring inconvenience and utilizing available resources to live in a familiar environment." Participants faced challenges such as limited healthcare, isolation, and difficulty managing chronic illnesses. However, their desire to age in place was rooted in preserving their hometown's history. To cope, they practiced healthy behaviors, used social welfare services, and adapted their homes for safety. Four stages emerged: "preserving," "enduring," "utilizing," and "living." Our findings highlight the need for policies supporting older people with chronic diseases in rural areas to maintain their independence and connection to familiar environments.