This booklet examines the unique difficulties of delivering education services to at-risk children and youth with exceptionalities who live in rural areas. An introductory chapter considers the extent of the problem and identifies such strategies as providing self-esteem education, appropriate preservice and inservice training, community-business-school partnerships, family involvement, and community education. The second chapter provides a synthesis of the research, noting the high dropout rate in rural areas, conditions placing rural students at risk (e.g., poverty, limited English proficiency, and migrancy), and problems associated with implementing special education services (e.g., scattered populations, isolation, and a lack of social services). Implications for practitioners are considered in the third chapter, such as the need for program design based on the uniqueness of each rural community. Nineteen factors to be considered in service delivery design are discussed, such as cost efficiency, and expertise and attitudes of available personnel. The last chapter identifies recommendations regarding policy, preservice and inservice training, school programming, community action, parent activities, teacher concerns, and individual student concerns. Includes 30 references and suggested resources including examples of successful service delivery models. (DB)