Purpose of review: This review explores global developments in palliative care provision in rural settings, since 2010. It highlights models of rural palliative care provision including challenges faced in establishing services and draws upon examples from around the world. Recent findings: Recent literature reports developments in palliative care provision in rural and remote areas, with emerging and innovative models of care. However, many challenges remain and practitioners need to continue to ‘think outside the box’ in terms of palliative care provision. Models for rural palliative care provision are evolving, particularly in sub-Saharan Africa, which embrace the ‘culture’ of rural communities, demonstrating that palliative care can be effectively provided in rural and remote areas. Challenges to palliative care provision in rural settings continue to be identified, with the overarching challenges being mirrored in different settings and countries. Summary: Although culture and geography will change, challenges to providing palliative care in rural settings appear to be almost universal. Lessons learnt from developing palliative care in rural communities can be shared and applied in different areas. Caution is raised in transplanting urban models to rural settings, thus emphasizing learning from other rural settings to provide accessible and appropriate palliative care.