Objective: Key factors which positively influence recruitment and retention of doctors to rural practice include rural background and positive rural training experience. Despite this knowledge, there is no well-established conceptual framework to explain how these factors influence intention. The aim of this study was to consider rural practice self-efficacy and its influence on rural career choice by doctors. Questions relating to self-efficacy were formulated using Bandura's four proposed sources of self-efficacy, which include mastery experiences, vicarious experience, social persuasion and emotional and physical response to experiences. Design: Cross-sectional study. Setting and participants: Medical school graduates from Flinders University, who completed a rural year as a part of the clinical component of the course between 1997 and 2015. Main outcome measures: Rural self-efficacy; current and intended location of practice in small rural communities (<25 000 people). Result: It was found that 28.5% of participants were currently working in communities of <25 000 people. Levels of intent for future small town rural practice were consistent across career stages after internship. Higher rural practice self-efficacy scores were found in doctors working in smaller towns (<25 000) and small communities (<10 000). Higher self-efficacy was also associated with rural background, more senior career status, earlier speciality decision time and smaller expectation-experience gap. Conclusion: An independent association exists between rural self-efficacy and intention to remain or return to small rural practice. The article offers rural clinical schools the opportunity to consider how they can influence future rural career outcomes.