Improvements in individual and community resources are complicated by inadequate rural public policy and increasing difficulties in the delivery of services, including health care. This article examines rural service delivery, particularly the delivery of health care, and public policy issues in the context of persistent rural poverty. Barriers, including those at both individual and community levels, are discussed as well as artificial barriers that professionals may impose as they work to improve the life status of older rural adults. Initiatives currently underway for the improvement of rural service delivery and issues regarding the development and implementation ofpublic policy responsive to rural areas also are discussed. Recommendations forfuture service delivery in and public policy for rural areas are noted. Central to this discussion is the recognition that any attempt to improve the quality of life for older adults m rural areas, particularly when applied to the reduction of current financial distress, will be developed and implemented during times of increased program and employee accountability at all levels.