Critical functions may go understaffed, scarce employees are often overworked, service quality and quantity suffer, and long-range planning becomes difficult. Isolated rural communities often suffer from medical services and facilities that are of lower quality than those found in metro areas. Even if medical care services were evenly distributed across the Nation, and were of equal quality, it is likely that nonmetro residents with chronically low incomes would still have serious difficulty receiving adequate care in a complex medical system where access is based mainly on the ability to pay. Because many rural communities are small and isolated, and lack financial resources and trained personnel, similar problems are encountered in the provision of other rural public services. Some communities that want to attract new residents and businesses may find it beneficial to cooperate with other towns and share in the cost of furnishing services they cannot afford by themselves.
Rural communities can work together in a variety of ways, and mutual aid is one way.
Such an approach is commonly used for fire and police protection. Another approach is for one community to sell a particular service to another. About 23 percent of isolated rural governments contract with other governments for solid waste disposal, about 19 percent for the operation of libraries, and 18 percent for assessing taxes. Still another method of cooperation is joint action, especially for large projects such as building and operating hospitals or airports. Various methods of dividing costs and creating joint committees or governing boards are worked out for such projects.