The Shetland Islands are the most northerly outpost of the United Kingdom. Shetland lies at 60 degrees North and is home to a population of 23,000 people on an archipelago of over 100 islands, 16 permanently inhabited. It is 110 miles north of the British mainland, 140 miles west of Norway, and 240 miles (by sea or air) north of Aberdeen Royal Infirmary, the closest tertiary hospital. The remoteness of Shetland and its substantial population necessitates the local presence of a capable surgical service. Four consultant general surgeons are currently in post with the expectation of working a 1 in 3 roster when “on island”, and they cover all surgical emergencies including some operative orthopaedics. There is a unique breadth and depth of skills required by the island surgeons, and the accrual of these has been greatly assisted by the Rural Surgical Fellowship. This fellowship is funded nationally by NHS Education for Scotland and provides up to 2 years of bespoke training, around or after completion of conventional general surgery training. It is ideally combined with a ‘proleptic’ appointment to one of Scotland’s 6 rural general hospitals and areas of focus will be tailored to the anticipated service needs. Elements can include Orthopaedics, Urology, Breast Surgery, Interventional Radiology and Obstetrics. Quality assurance is taken seriously. Surgeons participate in several weekly regional MDT discussions for cancer cases and orthopaedics. In recent years, appointed consultant surgeons have had regular humanitarian leave to work in low and middle-income countries. This has provided surgeons with experience of large numbers of complex major cases; otherwise hard to access while serving a small population. Shetland is an “unknown” to much of the UK let alone Australia, but their commitment and approach to providing a high quality locally led surgical service in a remote environment has many elements that could be adopted into the Australian system.