Rectal atresia is a rare cause of bowel obstruction in neonates with a normal-appearing anus. We present two different types of rectal atresia requiring different surgical management. Case one was a one-day-old term male with web-type rectal atresia diagnosed preoperatively with bedside obliteration of the web. Subsequent transanal web resection was performed. Case two was a one-day-old male born at 28 weeks weighing 980 g with significant cardiac defects including aortic atresia. The patient underwent initial colostomy creation and delayed rectal anastomosis via posterior sagittal anorectoplasty. We review the published literature, discuss the surgical strategy, and highlight the decision-making of diverting ostomy creation and approach of definitive anorectal anastomosis.