Rural acute surgical units in Western Australia (WA) are essential for Australians in rural areas but face significant challenges, including workforce shortages and geographical barriers. This review aimed to synthesize the current state of rural general surgery in WA—including caseload, scope of practice, and patient outcomes—to identify critical research gaps for improving service delivery. A narrative review of peer-reviewed literature, health service reports, and workforce data was conducted. The findings indicate that rural general surgeons manage higher procedural volumes and a broader scope of practice than their metropolitan counterparts. While many surgical outcomes are comp arable to urban centers, disparities persist in surgical oncology and trauma mortality, linked to access and transport delays. Key metrics such as unplanned returns to theatre (URTT) remain unquantified, and workforce shortages continue to hinder access to care. Significant research gaps exist regarding URTT rates, specific oncology outcomes, trauma morbidity, and the impact of access barriers, highlighting the need for targeted research to develop evidence-based strategies for equitable and sustainable surgical care in rural WA.