In the Patient Protection and Affordable Care Act of 2010, the Congress required that the Commission report on rural Medicare beneficiaries’ access to care, rural providers’ quality of care, special rural Medicare payments, and the adequacy of Medicare payments to rural providers. In addition to the findings presented on each of the four topics, this book presents a set of principles designed to guide expectations and policies with respect to rural access, quality, and payments for all sectors. This book also discusses multi-enterprising farm households and the importance of their alternative business ventures in the rural economy. The United States Department of Agriculture (USDA) administers the greatest number of rural development programs and has the highest average of program funds going directly to rural counties (approximately 50%). An overview of the USDA rural development programs is provided in this book.