In China, there are more than 2 million new strokes annually, and the disability-adjusted life-years due to stroke were higher than any other disease. With aging of the population, inadequate control of vascular risk factors such as hypertension, and uneven distribution of specialized stroke care, the burden of stroke will continue to increase. Despite improved health care quality in China, the availability of specialized stroke care varies across the country, especially in rural areas. Stroke prevention, management and research face unique and severe challenges due to rough terrain and economic underdevelopment in Southwest China. In the future, efforts should be made to provide more balanced availability of specialized stroke care services across China, promote generalization of evidence-based practice, and carry out more high-quality research to improve outcomes of stroke patients, with special attention to the rural population and Southwest China.