Maintaining both access and quality to health care services in limited resource areas is a challenge. People living in remote areas face greater health challenges than their non-remote counterparts. It seems that simply living some distance from health care providers can create disparities in care that are difficult to overcome. Public or designated health care providers play an important role in maintaining access to health care services in addition to telemedicine. Moreover, health care delivery and payment reforms, such as pay for performance and accountable care organizations, may improve quality of care in limited resource areas.