Background: A robust Primary Health Care (PHC) system is critical for efficient and equitable health system. There is a paucity of research addressing the predictors of its utilization and related patient satisfaction. Aim of the study: to develop models to identify the predictors of utilization, preference, and satisfaction with the services provided in the PHC Centers in rural areas. Subjects and Methods: This analytic study with prediction modeling was carried in three PHC centers in Fayoum city on a random sample of 300 attendants. Data were collected using a selfadministered questionnaire with a scale for current visit and overall satisfaction. Results: Participants median age was 40 years, with slightly more males (56.0%); 35.7% preferred governmental health care settings, 30.0% were satisfied with the current visit, and 23.3% had an overall satisfaction with PHC services. The crowding index, being on medication, having previous hospital admission or surgery were positive predictors of PHC utilization. Having chronic disease and a private health insurance were positive predictors of PHC utilization, while being female, having sufficient income, having a crowding index 2+, and being on regular medication were negative factors. Female gender was a positive predictor of satisfaction, whereas the crowding index, having a chronic disease, and having had a previous surgery were negative predictors. Conclusion: The models indicate that despite high utilization, participants have low satisfaction and low preference for governmental settings. These are influenced by their personal characteristics and health status. Recommendations: The PHC authorities need to identify the factors underlying this low satisfaction and take proper measures for reform. Future research should explore the effects of such reforms on patients' utilization and satisfaction.