The purpose of this study is to investigate the actual situation of lesson study in China and to analyze the formation mechanism of urban-rural differences in terms of lesson study. To this end, a survey was conducted in primary and secondary schools in southwestern China. A total of 2,042 teachers participated in the survey and 1,364 responses were used for analysis. The findings from the survey are as follows: 1) there are differences between urban and rural areas in the implementation of lesson study, and 2) the management system of school has no significant effect on this difference. However, factors such as leadership, research-oriented classes, frequency of activity, and time for prior discussion strongly affect urban-rural differences. Further, this study suggests long-term and short-term measures to improve the efficiency of lesson study in rural areas. The short-term measures include sending adequate teachers to rural areas and increasing the frequency and time of conducting lesson study. The long-term approach is to cultivate excellent leaders with leadership ability in rural areas.