Solo practice is the dominant mode of rural medical care delivery. At the same time, it is the most likely not to succeed, because the solo physician is choosing to leave the rural community. Group family practice is the most stable form of rural practice, is acceptable, and is sought by the majority of family practice residents seeking to establish new practices. Characteristics of successful rural practices include group practice, retention of the same health care providers for more than three years, a community-oriented focus, integration of non-M.D. health care providers, and a commitment to education within the practice. Academic medical centers with area health education centers (AHECs) should consider developing expanded AHECs to provide the education, planning, consultation, and expertise now needed by rural communities. Academic medical centers without AHECs should consider creating offices of rural health to provide the education, planning, consultation, and expertise needed in rural communities.