This article focuses on the implementation of service learning initiatives with rural populations to foster cultural awareness within undergraduate nursing students. The results of student reflections and how they relate to increased awareness of global rural health, cultural awareness, and health disparities is presented. Objectives: (1) To describe an international service learning project conducted through a short-term medical mission to the United Republic of Tanzania for Baccalaureate nursing students; and (2) explore student observations and perceptions regarding culture and health in a rural community. Overall, we hope to gain information about the impact of student experiences regarding international service learning, rural health, and cultural perspectives and awareness. Methods: The study used the qualitative method of reflective journaling to investigate student observations and perceptions during a medical mission trip regarding culture and health in an international rural community. Journals were analyzed using content analysis and thematic identification. Results: Student reflections revealed themes of increased awareness in global cultural differences, interprofessional relationships, compassionate care, and health disparities in a variety of rural settings. Students who participated in service learning initiatives within these international medical trips stated they were more globally aware and were now more likely to provide services to rural communities in their future nursing careers. Conclusions: This SL project effectively evaluated the benefits of a short-term international mission trip. Study results showed student benefits of increased awareness of community needs, decreased stereotyping, increased confidence in working with culturally diverse populations, and increased personal and professional growth for cultural competence. We identified a need to include and develop core interprofessional education competencies in future trips. Keywords: Rural, Rural health, Service-learning, Medical mission, Cultural competence DOI: http://dx.doi.org/10.14574/ojrnhc.v18i1.506