In the 1960s, it was discovered that there was a significant need for more physicians to serve the U.S. population, especially in rural and medically underserved communities. The Physician Assistant profession was built with the hope of being an extension to physicians to help meet these needs. However, there continues to be large numbers of communities in every state that lack access to health care. The purpose of this study was to explore the factors influencing Physician Assistant practice location choice. Methodology: A retrospective cross-sectional study of PA student records in a mid-western rural-focused physician assistant program was conducted. Application data from PA graduates in 2003, 2004, and 2005 were evaluated for desired community size of practice location at the time of application compared to actual job placement and community size after graduation. A written survey was mailed to the same classes of graduates to assess factors that influenced selection of their first and current practice location. Data were analyzed using frequency counts and chisquare tests. Results: There was a 44% response rate from the 126 eligible to participate in the survey. It was noted that 60% of applicants listed their preference specialty as family practice; however, less than one-third of graduates were currently working in the family practice specialty. Similarly, applicants noted a preference to work in rural areas, but upon graduation for their first job and current job they tended to work in urban areas by a large percentage. There were five different factors with significant relationships in regard to PA practice location (p<.05): Significant others support of location, quality of life, employment opportunities for the significant other, scope of practice and recreation. A significant others support of the location appeared to be most important. Conclusion: Choice of employment at the time of application compared to graduation was markedly different. Choice of practice location did not appear to be a decision made by the graduate physician assistant alone, but also in conjunction with their significant other.