The rural community mental health center tends to serve a large geographic area, have decentralized service delivery, require its professionals to function as generalists, and coordinate closely with other agencies. The last decade has seen an increasing strain placed on this pattern. As block grant and fee-for-service shifts resulting from the Omnibus Budget Reconciliation Act of 1981 took hold, the rural community mental health center was forced to step away from its role as a multiservice agency accessible for general community utilization and into a narrower role of service provider to the seriously impaired or those able to pay. In already underserved rural areas, this has generated immense challenges for mental health professionals to provide services to persons other than those with chronic mental illness. Successful alternatives and innovations are discussed, including linkages with primary care physicians and training indigenous residents to provide basic mental health services under professional supervision. Innovative rural prevention programs link parents and young children to child development professionals, build self-esteem in at-risk youth, respond to families affected by the farm crisis, and detect and prevent school adjustment problems. A literature review found few rural programs addressing the issues of substance abuse; services to women, children, the elderly, those with severe mental illness or developmental disabilities, and the homeless; or crisis intervention. (Contains 59 references.) (TD)