Based on a North Carolina Feasibility study (1967-73) which focused on development of a pattern for providing comprehensive mental health services to rural people, this guide deals with programming and administrative problems in Vance and Franklin counties. Describing those problems believed to be most likely to occur in rural areas, this booklet details the following: (1) Problems Arising from the Community Organization Approach (evocative vs. benevolent policy; pressures to accept statewide program goals; citizen expectations of expert management; local professionals' desire to unload their responsibilities); (2) Problems in Serving a Rural Population (reaching the rural poor; influence of stigma and social visibility: transportation; improving services to minority groups via human relations councils); (3) Problems of Operating a Limited Clinical Program; (4) Internal Administrative Problems (using a staff of commuting professionals and outside resource people; learnings re administrative time; communication; leadership; divisive social and professional pressures affecting staff cohesion; staff status differences; budgeting and finance); (5) External Relationship Problems (local medical practitioners; physician clearance and referral of admissions; using a local hospital for local inpatient care, a case history of failure; binds between State and local rural programs; using university students). (JC)