The objective of this Legislative Symposium was to assess the rural health care system of the State of New York, and in light of the current influences on that system, to design a framework for rural health care over the next two decades. The tasks of the participants were to reconfigure the rural health care system and make proposals on system design, system development, and needs assessment. Over 125 people participated in the symposium and were divided into five workgroups: System Framework; Access; Reimbursement; Personnel; and Coordination. These workgroups outlined the central issues in each of these subjects with five common concerns: regulatory flexibility; reimbursement and financing mechanisms; coordination; networking and community strategic planning; and the unique character of rural needs, strengths, and conditions. Sections of the report are (1) "Executive Summary"; (2) "Synopses of Guest Faculty Presentations"; (3) "Creating the Proper Environment for the Development of Rural Health Systems"; (4) "The Rural Community"; (5) "Reconfiguring the Traditional Health Care Model"; and (6) "Workgroup Reports and Public Comment." Appendices include information about programs for rural health delivery; classification of New York counties on a metropolitan-rural continuum; a list of symposium participants; and a list of agencies, associations, and councils that directly affect rural health policy and delivery systems in New York State. This report is of potential interest to educators and policymakers concerned with the quality of life in rural areas and the antecedents of student performance in schools. It may also be of interest to extension educators and those involved in interagency collaboration. (ALL)