We read with great interest the editorial regarding the value of smartphones to anaesthetic practice in the developing world [1]. Many of the advantages noted, such as access to reference material, contact details, photography and education are also of considerable value in the UK, and particularly to colleagues in remote and rural areas. The Association of Anaesthetists of Great Britain and Ireland has developed standards for pre-hospital anaesthesia and inter-hospital transfer of patients [2, 3]. In both these circumstances, smartphone access can be highly relevant and offer significant improvements in quality of care and clinical governance. However, whilst mobile phone network coverage is generally ‘taken for granted’ in urban areas, many rural parts of the UK are still without cover (Table 1). In Scotland, the Emergency Medical Retrieval Service (EMRS) provides a critical care transfer service to remote and rural areas [5]. After repeated issues with network coverage, we surveyed the 66 sites covered by EMRS and found that 34 have no network providing ‘good’ 2G (phone and text) coverage, including five of the community hospitals (Arran, Barra, Portree, Golspie and Benbecula); 3G coverage was even poorer. Many rural staff and patients are subject to a digital divide that excludes them from the advantages outlined above. Comments from our rural colleagues are illuminating, some relying on carrying multiple mobile phones where single networks cover different parts of practices, others relying on pagers or innovatively using non-UK tariffs to permit ‘roaming’ of UK networks [6]. All these must inevitably increase NHS costs. Critical care skills, with the appropriate equipment, are transferrable to remote and rural environments. Although EMRS has developed a prize-winning app containing contact and logistics details, standard operating procedures and checklists for their service catchment area, the utility of this app is restricted by the poor availability of 3G service across rural areas. Whilst we fully agree with the editorial regarding the value of mobile phones in the developing world, we feel that the NHS should recognise the value of mobile communications in remote and rural areas and actively support improved coverage. The current position is detrimental to NHS service provision in terms of costs and quality of care, which should prompt a corporate response from the NHS to improve coverage for rural services in the UK.