The objective of the paper is to identify the determinants of access to health care in rural Russia. We started out with the observation that the transition process has affected the provision of social services in the Russian Federation in general, and in rural areas in particular, owing to the overlap with agricultural reforms. Based on this observation we asked how the reduced role of the state and the concomitant decentralization of policy making has affected access of the rural populace to social services. A review of the available literature on this topic resulted in the formulation of the following three hypotheses. Firstly, that income is a determinant of access to health care. Secondly, that informal payments play an important role in determining access, and thirdly that there are large differences in access to health care services between districts. The hypotheses were tested using household data from a survey conducted in two regions of Russia in 2000. The results indicate that in the study regions, contrary to expectations, neither income nor informal payments are important determinants of access. However, there are large differences in out-of-pocket expenditures between districts, indicating that access to health care varies between districts.