This paper contains preliminary findings from a 1989 survey of over 400 rural health programs serving chronically ill, handicapped, or high-risk children. Respondents identified major problems affecting service delivery. Follow-up research is continuing, but present data indicate that transportation problems, for both clients and staff, will probably have the highest ranking. Other frequently reported problems were: (1) issues related to recruitment, retention, and training of personnel; (2) limited program capabilities due to lack of stable funding, escalating medical costs, demands for documentation of services, and time demands; (3) inadequate referral sources in the community and insufficient locally-based resources; (4) family reluctance to utilize services, poor provider-family communications, cultural and language barriers, and social problems such as poverty and illiteracy; (5) lack of skilled physicians, physician unwillingness to accept children with special needs or low-income clients, and slow diagnostic and referral mechanisms; (6) lack of public awareness about how to identify and refer a child with special needs; (7) need for case management, interagency service coordination, and family and child follow-up; (8) need for articulated and coordinated state-regional-local systems; and (9) lack of access to tertiary (specialized) services. Program strategies developed to address these problems are listed. (SV)