While a quarter of the United States population lives in rural areas, only one tenth of the nation's physicians practice in those areas. As a result, rural Americans have a hard time receiving proper medical attention. In addition to the lack of available physicians, rural Americans also face economic, social, and cultural barriers to accessing health care. Many rural hospitals have either closed or are run down and lack proper medical equipment. Not surprisingly, rural hospitals have trouble convincing physicians to work for them.

The federal government has identified over 3,000 areas in the country which have an insufficient number of physicians. It has designated these areas as "nonmetropolitan health professional shortage areas" (HPSAs). The National Health Service Corps (NHSC) was established under the U.S. Department of Health and Human Services to help recruit and retain primary care clinicians to work in HPSAs, including dentists and mental and behavioral health professionals. The NHSC provides comprehensive team-based health care. It also offers scholarship and loan repayment programs, which are offered to physicians in exchange for their promise to work in HPSAs.

A number of states have similar programs in place to meet medical needs in rural areas. For example, Texas has a health careers fund that provides loan forgiveness to students from under-served areas who pursue medical careers and return to their home areas to practice. Likewise, Idaho and Nebraska have loan forgiveness programs for medical clinicians who agree to work in under-served areas. Other states have income supplementation programs to induce physicians to work in under-served areas. Six states give income tax incentives to physicians who practice in rural communities.

How effective these federal and states initiatives have been is unclear. In a 2004 report, the National Advisory Committee on Rural Health and Human Services determined that rural Americans are still in need of better coordination of primary health care and behavioral care, better access to oral health care, and better access to human services for the elderly. A government initiative entitled Healthy People 2010 established the following strategies for healthcare workforce development:

• Increase the proportion of federal, tribal, state, and local agencies that integrate specific medical areas into personnel systems.
  
• Increase the proportion of schools for public health workers, which address care for services essential to rural areas.
  
• Increase the proportion of federal, tribal, state, and local agencies that provide continuing education to rural health care workers in the essential services.

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