Abstract: This study explores the “last-mile” implementation challenges of the Sanming healthcare reform in rural areas and how the lack of medicine, medical staff, and access to healthcare affects villagers’ experience of healthcare services. The study is based on qualitative fieldwork that took place in the summer of 2025 in three villages in Sanming, which included semi-structured individual interviews and informal group discussions with eight participants: elderly villagers, a village head, a former medical insurance bureau director, a township hospital manager, and a medical staff member. The results highlight three interrelated challenges. Firstly, there is a constant lack of medical staff in rural areas and frequent staff rotation. And medicine is also limited in supply due to centralized procurement. Secondly, the capacity of township facilities to handle complex and urgent conditions is limited by their diagnostic capacity, equipment, and delayed emergency transfers. Third, the lack of trust in grassroots providers, low health literacy, traditional treatment preferences, and dissatisfaction with insurance payments also limit the effective use of services. The reform efforts are constrained by the disconnect between the standardized policy design and local needs at the grassroots level. The study suggests that the implementation of reform should focus on stable rural labor force, locally responsive medicine supply, increase emergency capacity, and services that villagers can understand and use.