Background: Necrotising fasciitis (NF) is a rare but life-threatening soft tissue infection. In the head and neck (HN) region, it is associated with up to 70% mortality rates. It can pose a diagnostic challenge due to the rare nature of this infection, overlapping clinical features with less severe infections, and lack of gold standard diagnostic testing. In rural and regional areas, HN NF treatment is further complicated by limited resources for investigations, operative treatments, and timely transfer to a centre for definitive management. We aim to review presentations, management, and outcomes of HN NF in rural Australia setting, and raise awareness regarding importance of prompt intervention. Methods: Retrospective review of HN NF treated by Ear, Nose, Throat (ENT) team at Toowoomba Base Hospital (TBH) over 10 years from June 2013 to June 2023. Results: Five HN NF presentations were identified. No patients were diagnosed as HN NF on presentation prior to referral. Time from presentation to ENT referral ranged from 0.8–48 hours (mean 12.6 hours). Time to operative management was 2–52 hours (mean 26.7 hours). All cases required multiple operative interventions (4–10, mean 6 procedures), and two patients required tracheostomy. All required intensive care unit admission, and broad-spectrum intravenous antibiotic therapy. Two patients required metropolitan centre transfer for further subspecialty input. The remainder were treated within our ENT service. One patient died due to their infection. Conclusions: HN NF is a life-threatening infection that is difficult to diagnose and manage, especially in rural Australian settings. High clinical suspicion and early diagnosis is required to overcome the logistical and geographical barriers. This study demonstrates that with multidisciplinary approach, swift interhospital coordination, and ongoing education, favourable outcomes can be achieved for HN NF in rural ENT service.