Background: Health workforce crisis is a worldwide occurrence especially physicians. There is unfair distribution of physicians among urban and rural health institutions. Due this reasons there is serious shortage of physicians in the rural area mainly in Sub-Saharan Africa countries.

Objective: To assess intent to work in the rural settings and associated factors among Medical students of Jigjiga University, Ethiopia, 2019.

Methods: Institution based cross-sectional study supported by qualitative approach were   employed from April to May, 2019 at Jigjiga University medical school. The data was collected from 355 medical students drawn through computer generated simple random sampling technique. Structured pretested self-administered questionnaire and focus group discussion were used to collect quantitative and qualitative data respectively. Data were entered through Epid data version 3.21 and exported to SPSS version 23 for analysis. Bivariate and multivariate analysis of were done to determine the associated factors. The strength of the association was assessed using odds ratio (OR). Statistical significance was declared at P value less than 0.05 with 95%.

Results: Intent to work in the rural setting was found to be 29.5% (CI: 10.2- 23.6) of our medical students. The intention to work in the rural area were positively affected by being male [AOR= 5.457 (95%CI =1.879,15.849)] and having desire for career advancement opportunity (AOR= 8.045 (95%CI = 2.125,30.454)] in this study fining.

Conclusion: Majority of medical student’s intention to work in the rural setting is low compared to the others. Sex and availability of career advancement opportunity were positively associated with intention of medical students to work in the rural setting after graduation. Designing interventions to influence the attitude of medical students to work in rural location are expected from the medical schools and other stakeholders as well. On top of this increasing access for education should also be given attention.