Increasing the availability of primary health care in rural areas and, in particular, in small and hard-to-reach settlements is an urgent and strategically significant task from the point of view of the organization of public health and public health. Various factors, such as climatic and geographical features, transport accessibility, staffing availability do not allow using unified approaches to ensuring high availability of primary health care, as well as applying in real practice requirements based solely on population size. Due to the presence of such factors, the development of algorithms for making managerial decisions based on a detailed analysis of the situation in a particular territory is relevant. The purpose of the study was to develop a methodology for determining the availability of medical organizations providing primary health care in small and hard-to-reach settlements. When developing the methodology, the main approach was applied, related to determining the priority of measures to increase the availability of primary health care in settlements with up to 10,000 residents who have medical organizations (MO) or ambulance (SP) providing primary health care to the population. At the first stage, indicators were selected, taking into account the formed criteria for a comprehensive assessment of the placement of MO in small settlements. Data collection is carried out for each MO and joint venture from the Federal statistical observation form No. 30 "Information about a medical organization", data from the Federal Register of Medical Organizations, statistical reports of the territorial body of the Federal State Statistics Service, as well as based on the results of a survey of all the MO of the region in the context of individual joint ventures. The developed methodology makes it possible to compare the results of the implementation or absence of implemented measures to ensure the availability of primary health care in different time periods within the established volumes and regulatory waiting periods in accordance with the Program of state guarantees of free medical care to citizens.