Objective This study explored approaches of government policymakers to health policy evaluation (HPE) in Australian rural and remote settings. Methods Semi-structured interviews captured experiences and insights of 25 policymakers in the Northern Territory Department of Health. Data were thematically analysed using an inductive approach to coding and theme development. Results We identified five main themes about HPE in rural and remote settings: (1) centring the rural and remote context; (2) balancing ideology, power and evidence; (3) working with community; (4) strengthening policy workforce capabilities in monitoring and evaluation; and (5) valuing evaluation through leadership. Conclusion HPE is complex in any setting, however, policymakers navigate unique complexities in rural and remote health contexts. HPE can be enabled by developing policymaker and leadership capabilities in rural and remote settings and supporting co-design with communities.