NRW is carving out 7.8% of medical study spots—about 200 a year—for the Landarztquote, to land future doctors in rural practice after their studies and specialization. Break the vow and you owe 250,000 euros in penalties. The move aims to fix rural care gaps fed by an aging doctor pool, since more than half of NRW’s roughly 11,000 GPs are over 55. Natalia Kohl, 23, with a 2.1 Abitur, trained as a nurse first and then won a medical place through the quota; she must commit to ten years as a GP in a rural area after finishing medical school and specialty training. She studies in Cologne, grew up near Aachen, and hopes to work in the Eifel after graduation—close to home and to nature. In six years, NRW has allocated more than 1,000 places through the quota, and ten other states have copied the idea. Selection isn’t just about grades; it also weighs a medical-entry test and practical experience in medical, nursing, or therapeutic fields.