Objective To investigate the cognition and identity of rural order oriented tuition-free medical students at Gansu Medical College. Methods Using the method of questionnaire survey, in November 2019, 475 rural order oriented tuition-free medical students of three-year program from the year 2017 to 2019 at Gansu Medical College were investigated. The data were analyzed by F-test & t-test. Results The total score of professional identity was (3.4±0.7) in 2017, (4.1±0.7) in 2018 and (3.6±0.9) in 2019, and the difference of these three years’ students was statistically significant (P<0.01). The total score of students in 2018 with pre-service training was higher than that of students in 2017 and 2019 without training, and the difference was statistically significant (all P<0.05). The items which have lower recognition are like these: In 2017, “I fully understand the business scope and job responsibilities of village doctors”[38.9%(70/180)], “Village doctors can enable me to fully display my personal ability and expertise”[36.7%(66/180)], “I think that since the contract is signed, it must be performed unconditionally”[24.4%(44/180)] and “I think the development prospect of village doctors is very good”[37.1%(39/105)]in 2019. Conclusions The overall recognition of occupation of tuition-free medical students is low. Pre-service training is one of the effective ways to enhance the sense of professional identity by tuition-free medical students.