Andhra Pradesh province in southeast India is ground zero for a series of ambitious public health programs aimed to make affordable healthcare available to the rural poor. However, when these families travel to the city to find medical treatment, they must navigate a treacherous path through counterfeit pills, medical fraud, and hidden costs. An epidemic of farmer suicides bears witness to the heavy toll that unpayable medical bills incurred at private hospitals can take on families living hand to mouth in the Indian countryside. This tragedy has added desperation to the search for solutions. One such solution is the Aarogyasri Health Insurance Program, which uses India's ration card system to provide poor families access to healthcare. But is this program enough? The gleaming new medical equipment of private hospitals in Hyderabad may be open to poor families from the countryside thanks to programs like Aarogyasri, yet below this photogenic surface is a culture of medical fraud and ration card forgery. The changes in India's healthcare system must be more than skin-deep if farmers are to spend their earnings on food for their families rather than medical bills.