In a newly published article, “Sustaining rural maternity and surgical care,” Dr. Jude Kornelsen, Dr. Stuart Iglesias, and Dr. Robert Woollard comment on the “Joint Position Paper on Rural Surgery and Operative Delivery” they co-authored in 2015, this time focusing on three main issues: providing rural health service closer to home, the impasse on safety, and operative delivery. They look at how the adoption of health services provided closer to home has impacted three communities in rural BC. Next they present undeniable evidence that rural surgical care has long been facing a service closure crisis, similar to that of maternity care. They recognize the need for action, and follow this up with background information on the relationship between general surgeons and family physicians with enhanced surgical skills (FPESS), and how their professional links impact the international discussion on defining and evaluating “safety.” For the third issue, the authors comment on the importance of local caesarean section services, and argue that unless a link can be fostered with surgical programs, these too will be unsustainable in rural and remote areas. Finally, Drs Kornelsen, Iglesias, and Woollard present and discuss the current need for all health care professionals and partners to align for a system change. They suggest that while interprofessional relationships will require significant attention, such an alignment will enable responsible policy to be implemented and lines of accountability to be maintained in each essential jurisdiction.