MONTGOMERY Ala.
As a physician in a rural area, Dr. Deanah Maxwell knows there are times she'll be stopped in the grocery store or at church for advice sometimes not even medical advice. But for her, that's half the appeal of being a small-town doctor.

The Tuskegee native plans to return to her hometown, with its population of under 12,000, to set up practice after finishing her residency in Tuscaloosa. But Maxwell acknowledges that the increased social obligations that come with being a rural doctor aren't for everyone.

"When you go back into a rural area as a professional, you can't just go back as a person in that profession," Maxwell said. "People look to you for guidance in areas other than, say, just medicine, so there's a greater sense of responsibility."

To help prepare for the role, Maxwell has participated in the Rural Health Leaders Pipeline programs at the University of Alabama. The programs, like similar ones elsewhere in the country, recruit students from rural areas, give them specific medical training and help prepare them to be community leaders.

Expanding and improving rural health care is a cause that is dear to program founder and director Dr. John Wheat, who received the Distinguished Educator Award from the National Rural Health Association in May.

"I am a product of rural Alabama, and I am very much aware of the different opportunities to get medical care that exist there versus in urban and suburban Alabama," said Wheat, who grew up mostly in rural Sumter County outside Livingston.

Dale Quinney of the Alabama Office of Primary Care and Rural Health said that in 2006 there were 907 primary care physicians in Alabama's 55 rural counties and 2,137 primary care physicians in the state's 12 urban counties. Primary care physicians are those who work in family practice, internal medicine, pediatrics and obstetrics-gynecology.

Dr. Donald Kollisch of the Rural Health Scholars program at Dartmouth College in New Hampshire said the ratio of patients to doctors is about twice as high in rural areas as it is in urban areas nationwide. He said rural areas account for about 20 percent of the country's population but only have 10 percent of the nation's doctors.