When people think of the segment of the United States population most dependent on the health care safety net, they may first imagine the urban poor in crowded emergency rooms at urban public hospitals. Although this group no doubt has serious health care problems, residents of rural areas may, in fact, have greater health care needs and face access barriers that are no less substantial. Rural populations are generally older, poorer, and have lower levels of education than their urban counterparts. There are far fewer hospitals and physicians in rural communities; the time it takes to travel to health care providers is often greater and public transportation less available. These problems may be magnified in rural areas far distant from any urban center.