A separate but very much related issue is the acute shortage of mental health workers in many rural areas. Particularly in the rural West, where population density is low, recruitment of psychiatrists and other skilled professionals presents an enormous challenge. Many counties report vacancies in key positions lasting several years. Community mental health therefore takes on a different look in rural areas, especially in the West. Care may be delivered by whatever professionals are available. Primary care physicians often take on the role of psychiatrist in rural communities, and telemedicine and other techniques that allow few professionals to cover vast areas are widely employed. Wide distances distort the meaning of "community" mental health, and institutional care at state hospitals many hours' drive from home can be more common. Practices that have proven effective in more densely populated districts are often simply impractical in rural areas.

The unique needs of people with mental illness in rural states have been explored in detail by the Mental Health Program of the Western Interstate Commission for Higher Education (WICHE), in Boulder, Colorado. By collecting and analyzing data on mental health services in frontier counties (fewer than seven persons per square mile), WICHE has identified the greater challenges in service provision. At the same time, policymakers and providers in states with large rural areas have worked to identify services that are effective in such settings. ^[1]  

Another organization that focuses on the issues in rural mental health is the National Association for Rural Mental Health (NARMH). Founded in 1977 in order to develop and enhance rural mental health and substance abuse services and to support mental health providers in rural areas, NARMH has added the goal of developing and supporting initiatives that will strengthen the voices of rural consumers and their families.

Both WICHE and NARMH address recruitment and retention issues in the rural mental health workforce. ^[2]   NARMH maintains a job bank on its Web site and provides information on recruitment through its annual conference.