Identifies rural communities that would be most affected should restrictions on IMG entry into the United States be tightened, and reports on the perceptions of physician recruiters and health planners about who might replace IMGs currently working in such areas. Findings indicate that given the difficulty of expanding ongoing recruitment and retention efforts, many underserved rural areas would likely remain underserved in the event of a cutback in IMGs, and many rural areas that are currently adequately served could face serious problems as well. A single national solution to replace IMGs would be difficult. Recruiters and planners within states and local areas will need to expand creative and innovative approaches, and even then, many rural communities might have to make do with less.