AIM: The current study reports technical and social details aiming to evaluate difficulties faced while performing laparoscopic appendectomy (LA) in a rural hospital as well as providing solutions. METHODS: Patients who underwent LA with a diagnosis of acute appendicitis between April 2009 and December 2010 were included in this study. Demographic details, operative findings and postoperative outcomes were analyzed. RESULTS: Fifty-one consecutive patients (28 male and 23 female) underwent LA. The median age was 23 years (range, 13-74); the median operative time was 45 minutes (range, 20-75). Appendiceal base securing was performed either endoloops in 4 (7.8%), or via intracorporeal knot tying in 46 (90.2%) patients and 1 was sutured. Complicated/technically difficult appendicitis was faced in 20 (39.2%) patients. One patient underwent conversion to open procedure (2%). Mean postoperative hospital stay was 2.4 ± 0.8 days. Postoperative intra-abdominal abscess occurred in 1 (2%) patient. CONCLUSION: LA can be performed safely in a rural hospital, even for complicated cases. In this study, we have discussed some technical and social difficulties encountered and the solution methods adopted when performing LA in rural settings.