This paper focuses on the difficulties faced by rural school districts in their efforts to serve children with severe multiple disabilities. Both historic and contemporary views on mainstreaming and inclusion of students with multiple disabilities are presented. Concerns of educators about the inclusion of such students center around the amount of time required to ensure appropriate inclusion. Suggestions offered include the use of student-centered learning approaches such as cooperative learning, holistic approaches to reading and language instruction, and curricular modification. Mainstreaming advocates believe that special education teachers require in-depth training and extensive support. Suggestions for rural schools include: (1) computer applications utilizing Internet, e-mail, and distance learning; (2) team teaching interactions at both the elementary and secondary levels; (3) peer tutoring and service education (experiences in volunteerism) of mainstreamed public school students who can assist their special education counterparts; (4) collaboration between nondisabled and disabled students in after-school activities; (5) involvement of faculty in nonschool activities; (6) working relationship with community medical and health care professionals; and (7) professional educators serving as an integral part of family support systems. Contains 14 references. (CDS)