This study examined variation in maternal complication rates following normal vaginal delivery among 282 rural hospitals throughout the United States. Using a risk-adjusted model to control for case mix, discharge abstracts of more than 84,000 women were analyzed to determine whether there were differences in outcomes resulting from, or concomitant with, their hospital stay. After risk adjustment, the majority of hospitals were found to be performing at an acceptable level; however, there were some factors associated with poor performance. Hospital volume and the availability of obstetricians in the county in which the hospital was located were found to have an inverse association with complication rates, whereas low county per capita income was found to have a positive association with poor facility performance. No association was found between complication rates and general practitioners and the degree of remoteness as defined by distance from the nearest tertiary care facility. The results demonstrate a relationship between volume and outcome and a threshold point at which volume becomes a significant factor in predicting facility performance. As well, a relationship is seen between physician specialty and outcome, in which obstetricians are significantly associated with facility performance at expected or better-than-expected levels. Normal vaginal delivery is an important service provided by rural hospitals. The relationships among volume, physician specialty and outcome suggested by these findings require further in-depth examination of specific factors that affect patient outcomes and overall facility performance.