One in five Americans lives in a rural area. The definition of "rural" varies, but generally it is understood to mean a sparsely populated nonurban area. Rural populations are very different one from the other, as is the geography of the regions they live in. For example, rural populations include seasonal farm workers, Native American and Alaskan populations, and so-called frontier communities, those with fewer than six residents per square mile. The diversity of rural populations presents unique challenges in terms of health care. But all these communities have some things in common.

First, the decline of traditional rural occupations such as farming, mining, and timber has reduced employment opportunities for rural residents, contributing to poverty. Because poverty narrows the economic base from which health care delivery services are funded, rural residents have reduced access to essential health care services. Second, there is a higher concentration...