The availability of health personnel in the rural areas of poor countries is generally seen as problematic. This paper contrasts a lottery‐based assignment of personnel between rural and urban areas to a free‐market solution in which personnel are paid a premium to accept a rural posting. The lottery system can lower total cost and increase the number of personnel in rural areas. The model benchmarked with published estimates of the premium that would be required under a free market suggests gains from the lottery could be substantial.