The intent of this project was to determine the financial impact of the rural economic crisis on rural community health centers. A 1986-87 survey reported changes in accounts receivable, bad debt, and sliding fee use, and the effect such changes may have on the cash position of rural community health centers. Of 284 rural community and migrant health centers, 183 surveys were returned, a 64% response. The data was compared with independent Public Health Service data. This final report confirms 1987 increases of 12.33% in sliding fee users; 11.23% in sliding fee discounts; 27.84% in medical bad debt; and 14.71% in medical accounts receivable. Nationwide, all centers experienced a decrease in cash position of $13,458,494 in 1987 over 1986. That means the centers needed $13.5 million more than they had available from income. The only way to fund this deficit would be to use cash reserves, increase debt, or increase accounts payable at the end of the year. There is a wide range in the regional impact. Some regions are experiencing a crisis, while others may be stable. This report verifies that there is significant economic stress in rural areas and shows that this stress has resulted in an increasing number of people unable to pay for health services. While centers have attempted to respond, they are losing the battle. If the trend is not stopped, many centers will not survive. (Author/TES)