The medical workforce shortfall in rural areas is a major issue influencing the nature of undergraduate medical education in Australia. Exposing undergraduates to rural life through rural clinical school (RCS) placements is seen as a key strategy to address workforce imbalances. We investigated the influence of an extended RCS placement and rural origin on the rural principal place of practice (PPP) of the first 3 graduate cohorts (2012–2014) from a Joint Medical Program offered by two universities based in northern New South Wales. Data was available for 426 eligible graduates. Participation in an extended RCS placement (odds ratio (OR), 6.075, 95% confidence interval (CI) 2.716–13.591), rural background (OR 3.613, 95% CI 1.752–7.450) and being 25 years or older at completion of a medical degree (OR 2.550, 95% CI 1.252–5.194) were all independently associated with rural PPP. Being bonded into a program to practice rurally was not associated with rural PPP. Participation in an extended RCS placement is strongly associated with rural practice in the first 3 to 5 years of practice for graduates from both rural and metropolitan backgrounds. This finding indicates that strategies to improve the rural workforce should focus on the promotion of rural placements, in addition to rural background.