Purpose: The differential diagnosis for skin lesions is vast and fraught with difficulty. A careful history and examination can reveal a rare diagnosis. Methodology: We present a series of four cases of zoonotic parapoxvirus hand lesions occurring in rural settings. Results: Case 1: A thirty-three-year-old veterinarian presented to Hamilton Base Hospital with a seven-day history of a growing left dorsal index finger bullous lesion. Viral PCR was significant for parapoxvirus (Orf). The lesion was dressed then regressed over six weeks. Case 2: A fifty-six-year-old sheep farmer presented to Hamilton Base Hospital with a two-week history of a large dorsal index finger bullous lesion, cellulitic with purulent material expressed. Viral PCR was significant for parapoxvirus. The secondary bacterial infection was managed empirically with cefalexin. The lesion regressed over eight weeks. Case 3: A sheepshearer presented to Wimmera Base Hospital with a two-week history of left middle and little finger necrotic pulp lesions. Computed tomography angiography (CTA) demonstrated no abnormalities. Infectious disease consultation suggested likely parapoxvirus infection. Biopsy and histopathological examination were in keeping with Orf. Case 4: A fifty-one-year-old nurse presented to University Hospital Geelong with a five-week history of a left thumb lesion growing following a lamb bite, clinically consistent with Orf. Hyper-granulation tissue was managed with silver nitrate cautery. The lesion resolved over two weeks. Conclusion: Zoonotic viral infections can present as painful and unsightly lesions on the skin. This case series demonstrates the need for a broad differential in assessing skin lesions in a rural hospital setting.