We compared University of Alabama medical students’ 1980-1981 practice location and specialty preferences with actual practice locations and specialties in 1991 with the following results. (1) Primary care physicians were located mostly in small or large communities, whereas larger than expected numbers of subspecialists practiced in smaller cities. (2) Actual proportions in primary care and surgical subspecialties were less than in earlier preferences; more than expected chose nonsurgical subspecialties. (3) Large city practice locations showed an increase in 1991 at the expense of earlier preferences for medium-sized cities. We suggest that the shift of primary care physicians to larger cities reflects concerns about the financial viability of small town practice, coupled with greater earnings in affluent suburbs. Excess numbers of subspecialists in smaller locations may be due to a perceived oversupply of subspecialists in larger cities.