Rural general surgeons play a critical role in managing diverse and complex surgical cases, often necessitated by the limited availability of surgical subspecialties in remote healthcare settings. Mount Isa Hospital (MIH) is a rural hospital in far North Queensland that serves as the main public referral centre within the North-West Hospital and Health Service. It has department of general surgery, however, there are no further surgical subspecialty services on-site, nor an on-site intensivist. The nearest subspecialty services are at Townsville University Hospital, 900 km away. This study analyses inter-hospital transfer data from MIH general surgical department over 12 months in 2024 to highlight the breadth of surgical skills and knowledge required for general surgeons in rural practice. Of the 1,902 total surgical admissions; 268 patients required transfer to tertiary centres, with 110 orthopaedic patients and 29 general surgical patients accounting for the majority of cases, followed by neurosurgery, maxillofacial surgery, and urology. Transfers depended on case acuity and retrieval availability, requiring general surgeons to manage cases locally. Some conditions typically handled by subspecialists were managed conservatively by general surgeons with guidance from subspecialists when required. The findings highlight the need for rural general surgeons to maintain broad competencies across specialties to stabilise patients until transfer or provide definitive care. General surgical training should include remote hospital rotations to expose trainees to diverse pathologies. Investments in local orthopaedic, intensive care, and anaesthetic services would enhance the capacity to manage complex cases locally, reducing transfers and improving outcomes in remote regions.