Securing equitable access to health services for rural and remote populations continues to be a challenge for governments and policymakers around the world. At the core of this complex challenge is a global shortage of well trained, skilled, motivated health workers. In 2016, the World Health Organization (WHO) estimated a shortfall of 18 million health workers to achieve universal health coverage by 2030, primarily in low- and middle-income settings. Shortages are often felt most acutely in rural, remote and hard-to-reach areas, where health workforce densities are generally lower than national averages. Even in settings where national shortages are not observed, issues of maldistribution can occur, leaving some populations behind. Rural populations, which tend to be poorer and less healthy, fall disproportionately into this category. It is crucial that issues of density and distribution of health workers are addressed in order to attain better health outcomes for rural populations. Addressing inequities in density and distribution are also key to maintaining commitments to primary health care, universal health coverage and the Sustainable Development Goals. There are also opportunities for health systems to contribute to sustainable and inclusive economic development in rural and remote areas. Investment in a transformed health workforce has the potential to create the conditions for inclusive economic growth and job creation, thereby promoting greater economic stability and security. Such investment can play a transformative role in expanding and financing decent work opportunities for women and youths in rural and remote areas, who are often among society’s most vulnerable. The policy recommendations within this guideline address the wide range of factors influencing rural health workforce shortages and distributional inequities. The challenges involved in the development of a competent rural health workforce, including the supply of health workers, their education, training and competencies, and creation of the capacity to absorb, retain and effectively manage health workers where they are most needed, are addressed. The political economy and overarching governing systems, as well as the attractiveness of rural practice and positions, are also considered. Finally, guidance for the successful planning, implementation, monitoring and evaluation of rural health workforce development, attraction, recruitment and retention strategies are included as fundamental elements of the policy process.