Background: Indonesia is a vast archipelago country with over 17,000 islands. Many of the islands are in underdeveloped provinces with no neurosurgeon. Neurosurgery is often considered an expensive and sophisticated field to fund. Our neurosurgery department used the vision and mission of the medical faculty, which is “globally respected and locally rooted” to make a difference in many of the islands. Methods: Careful selection of provinces and candidates that involve local governments and hospitals within the province. This includes resident recruitment, planning and developing neurosurgical infrastructure in the province. Our program uses innovative neurosurgical techniques that are standardized to be applicable in underdeveloped areas. The residents are exposed to their province and hospital during the training. We optimize IT interaction, including teleconference, videoconference and telemedicine Results: At the fifth year of our program, we have sixteen residents from 8 underdeveloped provinces and have established MoU with 4 local hospitals around Indonesia. We have also sent residents to rural areas. We routinely participate in international teleconferences and videoconferences, including those with the Saskatchewan team. Conclusions: A well planned and structured neurosurgical program, with standardized processes and involvement of local officials, combined with extensive use of IT, is effective in preparing neurosurgeons who can provide quality care in underdeveloped regions.