Background: Inguinal hernia is one of the most common surgical conditions encountered worldwide, particularly in rural populations where delayed presentation and limited access to healthcare services often complicate management. The study aims to compare the outcomes of Modified Bassini’s Repair (MBR) and Lichtenstein Mesh Repair (LMR) for inguinal hernias in a rural population, focusing on postoperative pain, complications, recurrence rates, and patient satisfaction. Materials and Methods: A prospective, comparative study was conducted over 12 months at a tertiary hospital with 100 patients diagnosed with primary unilateral inguinal hernia. Patients were randomly assigned to undergo either MBR or LMR. Key outcome measures included operative time, hospital stay, postoperative pain (VAS score), complications, recurrence rates, and patient satisfaction. Statistical analysis was performed using SPSS software, with a significance level set at p < 0.05. Results: LMR had a significantly lower recurrence rate (0% vs. 2%), reduced postoperative pain (VAS 3.5 ± 1.3 vs. 4.6 ± 1.5, p = 0.02), and shorter hospital stay (1.9 ± 0.4 vs. 2.1 ± 0.3 days, p = 0.04) compared to MBR. Operative time was longer for LMR (75.4 ± 12.8 min vs. 60.2 ± 10.5 min, p < 0.001). Postoperative complications, including infection and seroma, were slightly lower in LMR but not statistically significant. Patient satisfaction was higher in the LMR group (96% vs. 84%, p = 0.05). Conclusion: LMR demonstrates superior outcomes over MBR in terms of lower recurrence rates, reduced postoperative pain, and shorter hospital stay, making it the preferred technique for inguinal hernia repair in rural settings. MBR remains an option where mesh placement is not feasible. Wider adoption of LMR in rural healthcare is recommended to enhance surgical success rates.