With demographic change, many rural regions in Germany face the challenge to ensure an appropriate provision of basic services, also for the increasing share of immobile population groups. Among others, the growing number of old and very old people will increase the demand for medical care. Although, on the whole health care in Germany is very good, in some rural areas its provision tends to be difficult. This paper presents findings of an empirical study on older people’s mobility options, obstacles that constrain the access to health care and related needs. In-depth interviews were conducted with elderly men and women living in Holzminden, a district in Lower Saxony already massively affected by demographic ageing and shrinking. The analysis reveals high car dependency among the elderly; those who cannot drive are highly dependent to be given a ride to all kinds of activities, including medical appointments. Satisfaction with family doctors is high but many will soon retire and might not find a successor. Access to medical specialists and emergency care turns out to be more complicated. Despite low accessibility, most appreciate the advantages of rural living and nearly none considers leaving the countryside. Yet, those who do not have family living close-by they can call on might be forced to leave rural home once not able to drive anymore.