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The purpose of the Fifth International Symposium was to build on the approach of the four previous symposia. The first symposium (1977) focused on the impact of grain dust and health, the second symposium (1985) highlighted the broad range of health and safety issues in agriculture, the third symposium (1992) challenged us to think of health and safety issues in agriculture in the context of sustainability, and the fourth symposium, Rural Health and Safety in a Changing World (1998) (see 2000 Journal of Agricultural Safety and Health, vol. 5, issues 1-4), moved toward a broader approach to agricultural and rural health issues. We named the Fifth International Symposium The Future of Rural Peoples because of the increasing realization that the health of rural people needs to be considered in the context of the economy, the environment, and the community. We hereby summarize some of the thoughts and recommendations of 450 researchers, practitioners, policymakers, and rural people. The symposium was enriched by the participation and support of the Canadian Agriculture Safety Association, the Canadian Rural Health Research Society, the Agromedicine Consortium, all ten National Institutes of Occupational Safety and Health (NIOSH) agricultural health and safety research centers (High Plains Intermountain Center for Agricultural Health and Safety; Pacific Northwest Agricultural Safety and Health Center; Southwest Center for Agricultural Health, Injury Prevention, and Education; Northeast Center for Agricultural Safety and Health; Southeast Center for Agricultural Health and Injury Prevention; Great Plains Center for Agricultural Health; Midwest Center for Agricultural Research, Education, and Disease and Injury Prevention; Western Center for Agricultural Health and Safety; Great Lakes Center for Agricultural Safety and Health; and Southern Coastal Agromedicine Center), the National Childrens Agricultural Health and Safety Centre, and the agricultural production industry through Agrivision Corporation. Some 428 scientific presentations took place in Saskatoon, Canada, on October 18-23, 2003. The extent of the symposium is difficult to capture, with the articles in this edition of the Journal of Agricultural Safety and Health and this summary representing only a taste of the richness of the event.