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After the revolutionary conflicts of the 1910s, the Mexican state sought to bring peace to the country''s obstreperous, rebellious and often downright unknown rural provinces through the establishment of a new social pact. Peasants were to embrace political loyalty, productivity, and secularization in return for land, education and healthcare. Success depended on multiple regional factors and even healthcare, often presented as a neutral, politically uncharged benefit, faced ample opposition. Using four examples, I seek to examine why certain regions embraced post-revolutionary healthcare, while others preferred to remain wedded to ‘traditional’ or Catholic medical institutions and practices. [Copyright &y& Elsevier]