This commentary highlights the potential consequences of the COVID-19 pandemic for India’s rural population in India. The rural health care system is not adequate or prepared to contain COVID-19 transmission, especially in many densely populated northern Indian States because of the shortage of doctors, hospital beds, and equipment. The COVID-19 epidemic creates a special challenge due to the paucity of testing services, weak surveillance system and above all poor medical care. The impacts of this pandemic, and especially the lockdown strategy, are multi-dimensional. We argue for the need to take immediate steps to control the spread and aftereffects and to use this opportunity to strengthen and improve its primary health care system.