No, any POVM, including POVMs whose elements do not have unit rank, can be interpreted via Naimark's theorem as a projective measurement in a higher-dimensional space.
Derivation of the dilated representation
More precisely, let $\{\mu_a\}_a\subset\operatorname{Pos}(\mathbb{C}^d)$ be a POVM, so that $\sum_a\mu_a=I$.
Define a linear operator $V:\mathbb{C}^n\to\mathbb{C}^n\otimes\mathbb{C}^m$ by
$$Vu = \sum_a (\sqrt{\mu_a}u)\otimes |a\rangle, \qquad u\in\mathbb{C}^n,$$
for some orthonormal basis $\{|a\rangle\}_a$ for $\mathbb{C}^m$. You can verify that $V$ is an isometry. Its Hermitian conjugate acts on basis vectors as
$$V^\dagger(v\otimes w) = \sum_a \langle w,a\rangle \sqrt{\mu_a} v, \qquad v\in\mathbb{C}^n,\, w\in\mathbb{C}^m.$$
This follows from the definition of the Hermitian conjugate via the inner product:
$$\langle v\otimes w, Vu\rangle = \sum_a \langle v,\sqrt{\mu_a}u\rangle \langle w,a\rangle = \langle V^\dagger(v\otimes w),u\rangle.$$
With these definitions, observe that
$$V^\dagger(I\otimes |a\rangle\!\langle a|) V \,u
= \mu_a u.$$
Hence, the POVM elements can be written as
$$\mu_a = V^\dagger(I\otimes |a\rangle\!\langle a|) V.$$
This is essentially the statement of Naimark’s theorem: $V$ is an isometry that embeds the states into a larger space, where a projective measurement on the basis $|a\rangle$ is performed.
The probabilities produced by the POVM then read
$$\langle \mu_a,\rho\rangle
= \langle I\otimes |a\rangle\!\langle a|, V\rho V^\dagger\rangle
\equiv \langle a| \operatorname{Tr}_1[V\rho V^\dagger]|a\rangle,$$
which is directly interpreted as evolving $\rho$ through the isometry $V$, and then performing a projective measurement on the ancillary space.
See e.g. Watrous' book, section 2.3, for more info.
Examples
You can find a few examples of POVMs in this other answer.
Consider here the somewhat trivial single-qubit two-outcome POVM with $\mu_1=\mu_2=\frac12 I$. This has elements that have rank 2, and following the procedure above we find dilations of the form
$$V = \frac1{\sqrt2}\sum_{a=1}^2 I\otimes |a\rangle.$$
In matrix form, this can be represented as
$$V = \frac1{\sqrt2}\begin{pmatrix}1&0 \\ 0&1 \\ 1& 0\\0&1\end{pmatrix}$$
I should point out that the way you represent $V$ (as any linear operator really) depends on the choice of basis. The matrix representation I'm using here would arguably be the one more naturally attached to $\frac12\sum_a |a\rangle\otimes I$ rather than $V$ itself, but as long as one knows how things are being represented there is no harm in using this representation.
Note also that the dilation isometry is not unique. It depends on our choice of basis in the ancillary space.
So, given an initial state $|\psi\rangle$, we get $V|\psi\rangle=|\psi\rangle\otimes|+\rangle$, and thus the outcome probabilities are $p(i) = \| (I\otimes \langle i|)(|\psi\rangle\otimes|+\rangle)\|^2=\frac12$, for $i=0,1$. Which is compatible with the POVM being such that $\langle\mu_i,\rho\rangle=\frac12$. Admittedly, this is a completely useless measurement which extracts no information from the state, I only use it to illustrate the procedure. Similar calculations can be performed in less trivial cases though, e.g. something like $\mu_1=I/2+\epsilon$ and $\mu_2=I-\mu_1$ for $\epsilon>0$ small enough.