Wilbur Larch, MD, operates the St. Cloud orphanage in northern Maine in the 1920s. The setting is a large apple orchard, in which the orphans help out in the cider house alongside migrant workers during the picking season. Dr. Larch, who delivers many illegitimate babies during his tenure as director of St. Cloud's comes to the conclusion that perhaps abortion is a better answer for some of the young women who land on his doorstep --- twelve year old girls, victims of rape and so on --- so he becomes an abortionist.

Homer Wells is one of the orphans growing up under his tutelage, who seems to be unadoptable. Although he is a bright and enterprising boy, he returns time and again. Dr. Larch realizes that Homer will probably spend his life at St. Cloud's, so Larch decides to train him to take over his profession as St. Cloud's abortionist. Homer is reluctant and refuses to learn the trade.

As in all Irving novels, the characters are complex and the plot is multilayered. Homer matures, falls in and out of love, the cider house workers present a special problem for Dr. Larch and Homer, and Dr. Larch is a largely flawed man with an addiction to ether. Perhaps the most political leaning of Irving's books, THE CIDER HOUSE RULES was written in 1985 after the whimsical HOTEL NEW HAMPSHIRE.