Objective: To investigate the reasons for complaint or non-complaint by rural consumers of health services. Design: Qualitative study using focus group discussion of hypothetical scenarios. Setting: Selected rural communities in the Loddon- Mallee region of north-western Victoria. Participants: Sixty volunteer participants in eight focus groups recruited through advertising. Main outcome measure: Issues and themes concerning circumstances leading to, and factors inhibiting, complaints about a health service and awareness of complaints mechanisms. Results: Compared with residents of larger towns, those of small communities were more likely to report they would complain to the local provider, whereas those in larger towns were more likely to mention Hospital Boards or the Commissioner. Deterrents to making complaints included the lack of services, scepticism about the role of complaints in bringing about change and an attitude that it was more appropriate to try to fix the problem than complain about it. Lack of awareness of appropriate complaint mechanisms which feed into quality assurance processes was also identified.