Objective: To provide a framework for investigating the influence of socioeconomic and cultural factors on rural health. Design: Discussion paper. Results: Socioeconomic and cultural factors have long been thought to influence an individual's health. We suggest a framework for characterising these factors that comprises individual-level (e.g. individual socioeconomic status, sex, race) and neighbourhood-level dimensions (population composition, social environment, physical environment) operating both independently and through interaction. Recent spatial research suggests that in rural communities, socioeconomic disadvantage and indigenous status are two of the greatest underlying influences on health status. However, rural communities also face additional challenges associated with access to, and utilisation of, health care. The example is given of procedural angiography for individuals with an acute coronary event. Conclusions: Socioeconomic and cultural factors specific to rural Australia are key influences on the health of residents. These range from individual-level factors, such as rural stoicism, poverty and substance use norms, to neighbourhood-level social characteristics, such as lack of services, migration out of rural areas of younger community members weakening traditionally high levels of social cohesion, and to environmental factors, such as climate change and access to services.