As a lifelong urban resident transplanted to a rural area, I definately see significant differences. However, I am careful to limit my comments to the specific rural area I just left because this is only what I know. I see significant problems with men dominating women, domestic violence, child abuse, drug and alcohol abuse, obesity, and unhealthly lifestyles. I see more racism than I saw in urban culture.
Before moving to that rural area, I never knew someone personally who had experienced domestic violence; that sure changed. Some of my fellow health care professionals even made fun of my healthy low fat diet and yoga routine just because it's foreign to them. To me rural issues seem to stem from poverty, lack of education and lack of exposure to differences, and lack of opportunities.
It seems to me that life is ~20 years behind the urban culture I came from. What I find so interesting is that so many of the rural residents believe they have an idealic community compared to "the big city" while I see urban culture as less dysfunctional in comparison. On the flip-side, though, I have seem more kindness and neighborly help in the rural area than I ever saw for years in the big city.
For our tiny critical access hospital practice is limited to a very narrow scope. Anything beyond a routine appy for example, is a flight out to the big city. And you've got to hope the 1 surgeon is in town when that appy is needed. Spend some time in our ED, though, and you will see scary things that typically appear in a level 1 trauma center - and you have to deal with it using limited resources until the chopper arrives.
This narrow scope does mean nurses lose some skills; however, the good ones learn their niche and excel at addressing the issues common to rural residents: poverty, lack of knowledge, barriers to healthcare such as traveling long distances, boundary issues due to everyone knowing everyone, unhealthy lifestyles (higher rates of obesity, smoking) etc. Sounds like a niche specialty to me!
I absolutely believe rural nursing could be served by specific nursing education aimed at the elements common to rural culture and living. For one thing, in the rural area I just fled, professional boundaries are nearly non-existent. You will see your doctor and/or nurse at the only grocery store in town, gas station, etc. I saw HIPAA violated. Issues of domestic violence and child abuse are much more prevalent. There are more barriers to health care.