The Australian Journal of Rural Health is currently celebrating its 20th anniversary. Following a review of the first decade of rural health published by the authors in 2002, this article outlines and reviews the range of policies that have impacted upon rural health in Australia since then. During the past decade there has been a raft of new policies and programs designed to bring about improved rural health outcomes, and some progress has been made. However, a number of significant barriers to overcoming the rural-urban health differential remain. Special consideration will continue to be needed to rural affairs generally and to health system reform and rural health in particular.