To reduce surgical complications related to smoking, some Veteran Affairs (VA) medical centers have implemented requirements that patients quit smoking prior to elective surgery. Rural-residing Veterans are more likely to be affected by this requirement as they are more likely to smoke, less likely to quit, and experience challenges accessing specialty care. The incentive of a desired surgery could be an opportune time (“teachable moment”) to assist patients in quitting smoking. Our study examined experiences and perceptions related to this cessation requirement to inform development of a peri-operative smoking cessation intervention.