Background: Appendicectomy is a common emergency surgical procedure for acute appendicitis, with laparoscopic appendicectomy (LA) and open appendicectomy (OA) being the two primary approaches. Despite the well-documented benefits of LA, its adoption in rural settings remains inconsistent due to various constraints.This study compared the clinical outcomes and patient acceptance of laparoscopic versus open appendicectomy in a rural Indian setting. Methods: A total of 103 individuals with acute appendicitis were included, with 35 undergoing laparoscopic appendicectomy and 68 undergoing open appendicectomy. Data on post-operative pain, length of hospital stay, complication rates, recovery time, and patient satisfaction were collected and analyzed using SPSS version 19. Results: The LA group reported significantly higher overall satisfaction, pain management satisfaction, and recovery experience compared to the OA group (p < 0.001). Postoperative pain was notably lower in the LA group at 24-, 48-hours, and 7 days post-surgery (p < 0.001). The LA group had a shorter hospital stay (2.3 ± 0.9 days) compared to the OA group (4.5 ± 1.2 days) (p < 0.001). The overall complication rate was lower in the LA group (8.6%) in contrast to the OA group (26.5%) (p = 0.029). Recovery time to normal activities was notably shorter in the LA group (8.5 ± 2.1 days) in contrast to the OA group (14.3 ± 3.4 days) (p < 0.001). Conclusion: Laparoscopic appendicectomy offers superior outcomes in terms of patient satisfaction, decreased post-operative pain, shorter hospital stays, fewer complications, and quicker recovery compared to open appendicectomy in a rural Indian setting. Recommendations: The adoption of laparoscopic appendicectomy should be encouraged in rural healthcare settings, with investments in training and equipment to overcome existing barriers. Further research should focus on long-term outcomes and cost-effectiveness in these settings.