In north India, unregulated medical practice is considered by many to be a sign of the failure of institutional rationality and “backward” quality of rural life. However, the work of self-made doctors can also be seen to engage key elements of institutional rationality as it is interwoven with the structure and ethos of development. This article explores what these practitioners and their work suggest about the imagination of institutions in rural India and the kinds of power this invokes. Through mimesis of key practices (namely, forms of talk and use of injections), self-made doctors tap into the authority of legitimate institutions to occupy lacunae in state health structures and redress (even as they reproduce) effects of privatization and repeated temporary health measures. At the same time, everyday elements of these practices demonstrate that institutional legitimacy can only be borrowed by those already in positions of authority (on the basis of caste status and political leadership), challenging ideals of equality that underlie health-related development efforts.