BACKGROUND Our system uses a hub and spoke approach to provide surgical care for our rural population. Patients access care anywhere in the system but are transferred centrally for surgical care. We sought to determine if surgical outcome differed depending on where initial care occurred. We chose acute appendicitis (AA) to investigate our care model. METHODS We identified patients admitted with the diagnosis of AA. Patients were divided into 2 groups, Bassett Medical Center presentation and satellite center (SAT) presentation. Demographics were compared and, time from system access to surgery, time of surgery, and clinical information associated with care. RESULTS There were no differences regarding any clinically relevant factor. SAT patients had longer mean surgery times, 60.7 minutes vs 51.5 (P=.008). Time to surgery, LOS, and complications were similar. CONCLUSIONS It is safe to care for AA patients with a hub and spoke approach without putting SAT patients at a disadvantage.