Three German economists analyze the determinants of access to health care in rural Russia and ask whether income and ability-to-pay, emerging as the major determinants of access in urban areas, have begun to govern rural populations' access to health-care services. Using household data from a survey conducted in the year 2000 (N=321 households) in two regions of Russia—Oryol and Leningrad Oblasts—the authors examine how the reduced role of the state and the concomitant decentralization of policy-making have affected access of the rural populace to health services. Broader policy implications and suggestions for ensuring future access to services in rural areas are offered.