This study investigated the differences in employment intentions between poor and nonpoor students in medical colleges as the basis for dynamic occupational guidance. Questionnaires were administered to 400 students from two medical universities. A higher proportion of poor college students had direct employment intentions than nonpoor college students. Poor students preferred to work in cities of all sizes. A higher proportion of nonpoor students wanted to work in their hometowns, communities, and western regions. A higher proportion of poor students hoped for well-paid jobs and prestigious occupations. In the employment process, both groups consistently considered crucial helpful factors including comprehensive ability, social relationships, and actual operating ability. Medical students should improve their skills and engage in community work. Ideological guidance should be strengthened in poor college students to help them choose occupations well.