Under the premise of emphasizing government leading and public welfare, what kind of medical and health system should be implemented in rural areas to ensure the accessibility and fairness of medical services is the main problem we should face and solve. This paper reviews the development process and governance structure transformation of rural medical security system in China from traditional rural cooperative medical system to new rural cooperative medical system, and evaluates the pilot situation of new rural cooperative medical system from two dimensions of system supplier availability and demander accessibility, so as to analyze the lack of system and put forward the development direction of alternative.