Climate change is projected to become the leading cause of adverse health outcomes globally, and the healthcare system is a key contributor. Surgical theatres are three to six times more pollutant that other hospital areas, and produce anywhere from a fifth to a third of total hospital waste. Rural centres have recently witnessed the impact of climate change with an increased frequency of drought and floods and are thus well motivated to improve the environmental sustainability of services. However, guidelines and scientific literature on how to make rural surgery more environmentally sustainable are lacking. This talk aims to address some of the key areas that rural centres can look at adopting, such as on site waste disposal, reducing transport environmental costs, and reducing low value care.