This study aimed to identify and explore the factors that are crucial to the successful operation of rural after-hours medical services. It sought to determine the attributes that contribute toward the successful operation of after-hours medical services in rural towns. It drew on computer-assisted telephone interviews with stakeholders, and operational, demographic and financial data. The findings were brought together and analysed within an integrated framework for the guidance of policy makers. In a rural setting, the most important factors for a successful after-hours medical service are related to, ‘place’, ‘process’, ‘people’ and ‘time’. These need to be integrated through effective management of relationships.