Main objectives of the present work were to develop an internationally agreed methodology for deriving optimized remediation strategies in rural areas that are still affected by the Chernobyl accident, and to give an overview of the radiological situation in the three affected countries, Belarus, Russia and Ukraine. Study settlements were defined by having in 2004 less than 10,000 inhabitants and official dose estimates exceeding 1 mSv. Data on population, current farming practices, contamination of soils and foodstuffs, and remedial actions previously applied were collected for each of such 541 study settlements. Calculations of the annual effective dose from internal radiation were validated with extensive data sets on whole body counter measurements. According to our calculations for 2004, in 290 of the study settlements the effective dose exceeded 1 mSv, and the collective dose in these settlements amounted to about 66 person-Sv. Six remedial actions were considered: radical improvement of grassland, application of ferrocyn to cows, feeding pigs with uncontaminated fodder before slaughter, application of mineral fertilizers for potato fields, information campaign on contaminated forest produce, and replacement of contaminated soil in populated areas by uncontaminated soil. Side effects of the remedial actions were quantified by a 'degree of acceptability'. Results are presented for two remediation strategies, namely, Strategy 1, in which the degree of acceptability was given a priority, and Remediation Strategy 2, in which remedial actions were chosen according to lowest costs per averted dose only. Results are highly country-specific varying from preference for soil replacement in populated areas in Belarus to preference for application of ferrocyn to cows in Ukraine. Remedial actions in 2010 can avert a large collective dose of about 150 person-Sv (including averted doses, which would be received in the following years). Nevertheless, the number of inhabitants in Belarusian and Russian settlements with annual doses exceeding 1 mSv remains large. Compared to international values for the cost-effectiveness of actions to reduce occupational exposures, the recommended remediation strategies for rural areas affected by the Chernobyl accident are quite cost-effective (about 20 keuro/person-Sv).