The government of Tanzania has made access to health care a priority. In particular, it has made great efforts to increase the number of facilities available to the rural population. By examining one such rural area, we find that although facilities exist and are staffed with competent clinicians, the quality of care received by patients visiting government facilities is subpar, especially that received by the poor in rural areas compared with urban areas. Importantly, nongovernmental organization (NGO) facilities provide better and more consistent care across the rural-urban divide. Access to high-quality care is inequitable, and this inequality is not inevitable.