The problems of access to health care by the underinsured demand a systematic response. One of the critical components of that response is medical curriculum reform, with the intent to graduate adequate numbers of physicians to do primary care, to work with the underinsured and the uninsured, and to practice in rural areas. One state, Minnesota, has developed a unique response to these needs, demonstrating problem solving very much in keeping with many of the recommendations in the literature. Highlighted in this article is the University of Minnesota's Rural Physician Associate Program, a predoctoral curriculum innovation functioning for 20 years to help resolve the issue of physician maldistribution in the state. The Rural Physician Associate Program provides students with many of the skills needed to provide primary care, it is cost-effective, and it has brought a number of benefits to the participating communities.