Academic health centers in the United States are in danger of becoming more and more irrelevant to the non-ter-tiary, primary health care needs of modern society. This paper explores options to respond to one segment that repeatedly has been demonstrated to be in distress: rural health care. Recommendations are made about selective recruitment into medical and other health schools to address the issue, early professional socialization, curricular reform, and the types of technical assistance that academic centers might well provide to rural practitioners and caregiver institutions. © 1990 Association of American Medical Colleges. All rights reserved.