OBJECTIVE: The purpose of the study is to provide current data on the composition and prevalence of rural general surgery residency programs and describe new mechanisms and resources facilitating the creation of such programs. DESIGN: Training site and program data for general surgery residencies for the academic year 2022 to 2023 from the Accreditation Council for Graduate Medical Education (ACGME) were geocoded and analyzed. A literature search and iterative consensus process with graduate medical education (GME) experts was used to synthesize and describe new mechanisms and resources to grow rural general surgery training. SETTING: Programs were designated as either having a rural rotation or the majority of training in a rural location (i.e. greater than 50% of training). Two definitions of rural were incorporated: nonmetropolitan Core-Based Statistical Area (CBSA) counties and Federal Office of Rural Health Policy area (FORHP) rural counties or census tracts. PARTICIPANTS: All listed general surgery residency programs reporting data to the ACGME. RESULTS: Less than 2% of ACGME-accredited general surgery programs spend the majority of their training in rural areas. Nearly 10% (n = 36) of programs have training sites in nonmetropolitan counties, and 13.30% (n = 48) of programs have sites in FORHP rural areas. Recent changes to GME funding policies and regulations have opened opportunities to expand rural GME programs. For example, existing residencies that increase their complement and establish a new rural site are eligible for Medicare GME funding. CONCLUSIONS: Despite new funding opportunities for rural GME, program development remains low among existing or new general surgery programs. Rural general surgery residency training could play an important role in addressing current and future general surgeon workforce shortages. Recent state and federal financing and assistance can be accessed to bolster rural rotations and residencies.