This document summarizes rural emergency medical services (EMS) in Virginia. It notes that about half of Virginia's counties are rural, with varied terrain. Rural EMS faces challenges like long response times, difficulty retaining personnel, and lack of funding. While rural EMS agencies have fewer calls than urban ones, they often have to travel long distances over difficult terrain. The document advocates for greater local government involvement to provide oversight, management, funding, and continuity of rural EMS services.