Within the United States, rural residents encounter a greater number o
f barriers in accessing health care services than their urban counterp
arts. In general, rural Americans have less access to both family plan
ning services and managed care delivery systems. Given the rapid chang
es in health care, we reviewed the implications for the provision and
integration of family planning and managed care services in rural area
s, where there is limited experience in establishing working relations
hips between those services. In many instances, family planning servic
es are well established in rural areas where managed care has not yet
penetrated. Our case study in Minnesota suggests that, although manage
d care and family planning services are developing in rural areas, the
re is little evidence of collaboration. Several innovative and success
ful family planning projects do exist in rural areas, however, and ser
ve as models of successful population-based programs that could work w
ell with health plans. Although this study concentrated on the provisi
on and utilization of subsidized family planning services, there is a
compelling need for further work to determine accurately where rural r
esidents are accessing such services and how the expansion of managed
care will affect the delivery of reproductive health care.