Objective: This study described the challenges for rural and remote Aboriginal people requiring transport to city hospitals for tertiary care. Design: Semi-structured qualitative interviews. Setting: South Australian rural and remote health services and tertiary hospitals. Participants: Twenty-eight urban health professionals from six hospitals and 32 health professionals from four rural and remote regions were interviewed. Twelve patients, three carers, four people responding as patient and carers, and one patient and carer couple were also interviewed, with eight elder women meeting as a focus group. Main outcome measures: The study identified specific structural barriers in urban health services or policy that prevented rural and remote Indigenous patients from receiving optimum care. Results: Problems accessing transport were identified as the most significant factor affecting access to care by the majority of patients and staff. They reported that travel to an urban hospital was costly, and coordination of travel with care was poor. A further problem was travelling while unwell. Conclusions: Travelling to a city hospital is a significant barrier for rural and remote Indigenous patients. Arranging and supporting travel is a time-consuming work that is not recognised by the health care system.