Rural generalists are required to maintain a very broad skillset to manage everything from chronic disease to hyperacute resuscitation scenarios. Research is lacking on how rural generalists develop and maintain a skillset necessary for management of critical illness in rural emergency departments. This study explores the experiences of rural practitioners in delivering critical care and maintaining a critical care skillset. Semi-structured interviews were conducted with six doctors working in rural emergency departments across Western NSW. These were analysed using reflexive thematic analysis to develop an overarching set of themes: the complexity of critical care in the community context, a complicated relationship with critical care support services, deterioration in local support, difficulties in accessing training, and the impact of community-centred critical care on practitioner wellbeing. This study demonstrates that rural generalists in Western NSW feel unsupported and undervalued in delivery of critical care. A variety of modalities for skills maintenance are used, but this is almost entirely self-directed. Review of the mode of employment of rural generalists and a proactive approach to supporting upskilling, as well as a focus on the whole hospital team, may stand to improve continuing education opportunities and have a positive impact on rural critical care delivery.