In summer 1994, a questionnaire was sent to all of the 822 allopathic and osteopathic medical students in West Virginia. They were asked if they planned to practice primary care in the state, and to rate the importance of financial, lifestyle, and educational factors that may impel them to practice in rural areas. The response rate was 51.8%. The results indicated that 70.2% of the students were unsure about their career plans, but they were considering staying in the state as primary caregivers. Financial factors such as tuition waivers, loan repayment programs, the improvement of Medicaid and Medicare reimbursement, and the elimination of the 2% healthcare provider tax were the most important incentives that students stated would influence them to remain in the state. Responses also indicated that lifestyle factors such as the quality of schools for children and having backup may increase participation in rural care. Educational factors were not found to be important reasons affecting students' decisions to practice in rural areas, and many students stated they were unhappy with the current mandatory rotations in rural care. Out-of-state students displayed great interest in both staying in West Virginia and in becoming primary care physicians. Few differences were found between students depending on what school they attended or their gender.