The current literature on the provision of rural financial services places far more emphasis on the sustainability of rural financial institutions as a means of ensuring effective provision than has been the practice to date. This paper reviews the various measures that have been used to measure both the efficiency (defined as effectiveness and productivity) and the outreach of rural financial institutions, as two key areas that have to be attended to if institutional sustainability is to be achieved. The results of some preliminary investigations into rural financial institutions in South Africa are then reported.