Nonmetropolitan and totally rural areas have greater unmet health needs and fewer health resources than urban areas. Blacks, American Indians, migrants, and Appalachians have specialized rural health care needs as a result of cultural isolation, poverty, and discrimination. The reversal of the rural to urban population migration has increased the strain on the health care system in all nonmetropolitan areas where the per capita distribution of physicians, medical specialists, services, and quality of facilities is significantly lower than in metropolitan areas. Communities need to develop specialized emergency medical transportation and communication, establish satellite clinics, and increase part-time physicians and midlevel health practitioners. A positive development has been the federal government's recognition of rural needs and design of eight programs to ameliorate rural health care problems: Community Health Centers, Migrant Health Centers, National Health Service Corps, Health Underserved Rural Areas, Rural Health Initiative, Rural Health Clinic Services Act, Loan Repayment, and Community Facilities Loan Programs. Under any national health insurance it will be important to recognize rural residents' health needs. The report compares four factors indicative of the condition of the health care system in both areas and shows that rural areas' lower incomes, larger aged populations, hazardous occupations, and lower educational levels contribute to poorer health care conditions. (NEC)