Objectives Types of surgery for rectal cancer (RC), including permanent ostomy (PO) or temporary ostomy followed by anastomosis (TO) or initial anastomosis (AN), can affect psychological and financial well‐being during active treatment. However, these relationships have not been well studied among long‐term survivors (≥5 years post‐diagnosis). Methods A mailed survey with 576 long‐term RC survivors who were members of Kaiser Permanente was conducted in 2010–2011. Prevalence of current depression was ascertained using a score of ≤45.6 on the Short Form‐12 version 2 mental component summary. Perceived financial burden was assessed using a Likert scale ranging from 0 (none) to 10 (severe). Regression analyses were used to measure associations after adjustment for covariates. Results The overall prevalence of depression was 24% among RC survivors with the highest prevalence among those with a history of PO (31%). The adjusted odds of depression among TO and AN survivors were lower than that among PO survivors, 0.42 (CI95% 0.20–0.89) and 0.59 (CI95% 0.37–0.93), respectively. Twenty‐two percent perceived moderate‐to‐high current financial burden (≥4 points). PO survivors also reported higher mean financial burden than AN survivors (2.6 vs. 1.6, respectively; p = 0.002), but perceived burden comparably to TO survivors (2.3). Self‐reported depression was associated with higher perceived financial burden (p < 0.001); surgical procedure history did not modify this relationship. Conclusions Depression was reported frequently among these long‐term RC survivors, particularly among PO survivors. Depression was associated with greater perception of financial burden. Screening for depression and assessing financial well‐being might improve care among long‐term RC survivors.Copyright © 2015 John Wiley & Sons, Ltd.