Medical schools in Russia are encountering a puzzling situation: although more students are applying than ever before, many intern positions remain unfilled. Despite a record number of applications, over 1,500 intern positions at major Russian medical universities were still vacant at the start of 2026. This includes 289 positions at Pirogov University and 211 at Setchenov University in Moscow. The issue arises from a new reform implemented in March 2026, which requires medical graduates to work in remote areas for several years. This policy is intended to address the shortage of doctors in rural regions, but it has created a new challenge in filling essential medical roles. The number of applications for state-funded medical positions has reached a record high, with the Ministry of Health recording 591,000 applications—26% more than the previous year. Nearly 19 candidates are competing for each spot, showing that the medical profession remains highly attractive to Russian high school graduates. However, the problem lies in filling intern positions, particularly in critical areas such as anaesthesia-intensive care, surgery, and oncology. Even in Moscow, where the most prestigious medical schools are located, there are significant numbers of unfilled positions, highlighting a growing contradiction between the popularity of the profession and the difficulty of placing graduates in key roles. Starting in March 2026, all medical interns who received state-funded training are required to work for 18 months to three years in a designated public hospital, often in remote areas. This policy, introduced at the end of 2025, echoes practices from the Soviet era, when the government assigned young graduates to specific positions. Those who refuse to comply face significant financial penalties, including repaying the full cost of their education, paying double that amount as a fine, and returning any scholarships they received. These penalties, combined with the unattractive nature of the positions, have led some students to avoid public internships altogether. Remote regions face significant challenges in attracting medical professionals. Siberia, which covers 77% of Russia's territory, has a population of about 36 million people and experiences extreme cold, with temperatures sometimes dropping below -40°C. A study by the Krasnoyarsk Medical University identified isolation, low population density, and harsh weather as major barriers for young graduates. In Kamchatka, a region with just over 300,000 people, five doctors died during the Covid-19 pandemic, worsening an already limited healthcare system. According to the chairman of the Duma, Russia was already short of around 23,300 doctors and 63,600 intermediate healthcare workers at the start of 2025, with the most severe shortages in the eastern regions. The impact of the new rule on healthcare in these isolated areas will likely become more evident in the coming years.