<p>Rural hospitals across the United States face declining access to surgical care due to workforce shortages, hospital closures, and limited availability of advanced procedural technologies. While telehealth has expanded consultation access, it does not address the core problem for many patients: the absence of local procedural capability. Recent advances in robotic surgery, secure teleoperation, and high-bandwidth networks now make remote procedural support and tele-robotic intervention technically feasible, but clinical deployment remains limited by fragmented technical standards, training pathways, regulatory structures, and payment models. International programs demonstrate that telesurgery can be performed safely when supported by defined connectivity requirements and coordinated oversight. In contrast, the United States lacks an integrated framework that aligns device regulation, communications infrastructure, clinical credentialing, liability, reimbursement, and hospital readiness. This paper proposes a readiness-based framework for tele-robotic surgery deployment in rural and resource-limited hospitals, organized across technical, clinical, and organizational domains. By defining objective requirements for safe and scalable implementation, this framework provides hospitals, clinicians, and regulators with a practical foundation for extending advanced surgical care beyond traditional geographic boundaries.</p>