Medical students that come from rural areas are more likely to return to rural areas to practice, but rural students apply for medical school at half the rate of urban students. Factors that contribute to this problem are the lack of rural representation on medical school selection committees; centralization of medical education facilities in urban areas; the perspective payment system, which contributed to rural hospital closures; the reduction of services brought about through managed care; reductions in federal funding; the "one size fits all" approach to legislation; and the urban perspective of most policymakers. Addressing the rural health care provider shortage will require: educational programs that give rural students the science they need to apply to medical school; role models for rural students; rural physicians on medical school selection committees; more residency programs with a rural training track; community empowerment to determine and meet local health care needs; development of students' sense of place by reemphasizing courses such as geography and history; policies that encourage the recruitment and retention of rural physicians; increased federal funding of programs for the rural poor; insurance for the uninsured; an environment for rural providers that is satisfactory socially, financially, and professionally and gives opportunities for growth; and local leaders that take responsibility for efficient use of available resources. (TD)