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The term 'rural' suggests many things to many people, such as agricultural landscapes, isolation, small towns, and low population density. However, defining 'rural' for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and economic differences across rural places--differences that have major implications for policy and research. Factors such as geographic scale and region also must be considered. Several useful rural taxonomies are discussed and compared in this article. Careful attention to the definition of 'rural' is required for effectively targeting policy and research aimed at improving the health of rural Americans. doi:10.2105/AJPH.2004.042432)

Objectives. Title VII of the Health Professions Educational Assistance Act of 1976 was created to encourage the production of primary care physicians. This study explored recent trends in the proportion of US medical school graduates entering primary care in relationship to Title VII funding. Methods. The American Medical Association Physician Masterfile was used to determine the specialty choice of all students graduating from American medical schools between 1960 and 1985. Results. The proportion of graduates entering primary care rose from 19.7% in 1967 to 31.1% in 1976 and remained stable for the subsequent decade. The increase occurred before implementation of Title VII. Rural, state-owned medical schools with departments of family medicine tend to produce a greater proportion of primary care physicians than urban private schools without family medicine departments. Conclusions. The values of American medical schools and the reward structure of American medical practice favor the production of specialists over primary care physicians. Although Title VII helped to encourage and sustain the development of primary care educational programs at both the medical student and graduate levels, an increase in the proportion of primary care physicians will require fundamental changes. (AmJ Public Health. 1993;83:322-328), The number of medical school graduates who choose to practice primary care medicine has not increased since the 1970s despite federal funding to increase the number of primary care physicians. Title VII of the Health Professions Educational Assistance Act of 1976 established special funding to encourage medical students to practice primary care medicine. A study examined the specialities chosen by medical school graduates between 1960 and 1985. Nineteen percent of medical school graduates chose to practice primary care medicine in 1967, compared with 31% in 1976. However, the number of medical school graduates who chose to practice primary care medicine did not increase significantly between 1976 and 1985. About $460 million in grants for general pediatrics, family medicine and general internal medicine did little to effect the distribution of medical students into primary care practices.