Telemedicine has emerged as a transformative modality in healthcare delivery, particularly accelerated by the COVID-19 pandemic, with profound implications for patient care quality and accessibility across diverse geographic contexts. This research article examines the differential impact of telemedicine in rural versus urban settings through a systematic review of recent literature and comparative analysis of implementation outcomes. Evidence indicates significant disparities in adoption rates, with urban patients utilizing telemedicine at nearly double the frequency of their rural counterparts (27.2% versus 16.1% during the pandemic), and isolated rural patients demonstrating 75% lower odds of telemedicine engagement (Sheets et al., 2021). While telemedicine substantially enhances specialist access, reduces transportation costs by approximately $3,800 per avoided patient transfer in rural emergency departments, and maintains comparable patient satisfaction rates to in-person care, critical barriers persist. Rural populations face structural challenges including limited broadband infrastructure (22% of rural Americans lack high-speed internet versus 1.5% in urban areas), lower digital literacy, and financial constraints with implementation costs ranging from $17,000 to $50,000 for rural hospitals. India's Telemedicine Practice Guidelines (2020) represent a landmark policy initiative, mandating three-year training for registered medical practitioners and establishing clear protocols for consultation, prescription, and data security. However, the digital divide threatens to exacerbate existing health inequities without targeted interventions. This article proposes evidence-based recommendations for bridging rural-urban gaps through infrastructure investment, policy harmonization, and culturally tailored implementation strategies to ensure equitable telehealth benefits.