This paper presents a novel method to determine the optimal routing of medium voltage distribution networks in sparse rural areas. The objective is evaluated through minimizing the net present cost of the network over a selected time period. A problem specific genetic algorithm is proposed to address the optimal network routing problem and compute the optimized topology throughout a geographically constrained region. The proposed method simultaneously considers non-fixed candidate lines to overcome search space restrictions through a variable length encoding structure and the use of Steiner points, and a shortest path algorithm to traverse between point-to-point connections in the constrained region. Geographical restrictions on network routing are considered through the formation of a rasterized map. The network is modeled at the branch level and considers both greenfield and expansion planning to highlight the effects of accessibility restrictions. The optimization model is applied to a real rural distribution network in the South-West of Western Australia. Alternative network topologies are found to provide significant improvements over the existing network and traditional reconfiguration based methods for evaluating the minimum cost sparse rural distribution network.