Rob, that sounds like a fun one, man. I love rural medicine. I did some work at a youth camp in the mountains this past winter, it was awesome. Just a PA and myself up there for around 90 staff and campers with transport about forty minutes away (or more depending on weather) and the closest ER about the same distance. The closest trauma center was close to an hour and a half away by ground. That really makes you take a personal inventory.
As a side note, three years in the field and my gag reflex finally met its match today: Weeping ulcers + incontinence of the bladder (which appeared to be going on for quite some time while the patient was unable or unwilling to access a laundry facility) + a really bad yeast infection. Our very own Adrobo can testify that it was horrendous. It put me out in the hall dry-heaving, eyes watering, nose running. Rather embarrassing