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Synopsis The primary health care in the rural areas is beset with many problems which affect delivery of services to the people in need. This paper examines various facets of rural health care and major issues of governance which impact its performance in the context of health policy and changes introduced in it after the onset of economic reforms. It also discusses major interests which impinge upon health governance. A major policy intervention by the Government, called the National Rural Health Mission (NRHM), which attempts to address these issues, has also been briefly dealt with. In this brief treatment of the subject, the reader would get an overview of the major problems in the public health system in the rural areas, why they arise and why they have failed to get resolved.