Town government ... when there's not much town to govern

If all this sounds like rural cronyism, think again. This is Adams County's bid for survival.

JUST OUTSIDE TOWN: Horses nose through grasses on snowy plains near Hettinger, N.D. ROBERT HARBISON - STAFF

Part 1: The dwindling heartland Part 2: The future of farming Part 3: Providing services for a decreasing population Part 4: Innovations on the frontier

Slideshow Alone on the Range

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With a dwindling population and tax base, this expanse of rolling farmland and brick storefronts is straining to maintain services for 2,600 residents spread over nearly 1,000 square miles. Never mind that median household income falls $600 below that of the poorest state in the Union. Or that the typical resident here has edged a decade closer to retirement than the national norm.

Somehow, the innovators of Adams - and other Great Plains counties like it - are finding ways to keep things running. That's one of the ironies of the reemergence of America's frontier (counties with fewer than six people per square mile). The new pioneers aren't those who move; they're the ones who stay and try something different.

Unfortunately, even the innovators are caught in the region's vicious demographic cycle. Two-thirds of the Plains' frontier is losing population.

As jobs dwindle, young people flee to the cities. Fewer young families means fewer children, which leads to a smaller pool of families in the next generation. As its tax base shrinks, the frontier's remaining residents are edging toward the stage in life where they're likely to demand more services. Already, a third of the region's households receive Social Security. At some point, economists and demographers say, the system simply breaks down.

"It's the phenomenon of a slowly sinking middle," says Lester Thurow, a native of Montana and now professor of economics and management at the Massachusetts Institute of Technology in Cambridge. By the time he retires, he predicts, "this will be the poorest part of America."

Can the region avoid that fate? Some frontier communities are experimenting vigorously - particularly in the public sector - to neutralize the effects of depopulation and wider open spaces. No one knows if they'll succeed in the long run.

On a snowy morning at the high school here in Hettinger, Bonnie Smith greets her English composition class in 21st-century fashion: by interactive TV. Although three students are sitting in her classroom, another dozen follow the proceedings from Scranton, 30 miles away, or Bowman, 40 miles away. Fax machines, microphones, and banks of monitors and cameras keep all three classrooms connected.

Mrs. Smith and the students manipulate the technology with ease. "I love this camera," Smith says of an overhead lens that broadcasts to the students what she writes on a pad. With it, she goes over a student's paper with the entire class - something that would be much harder in a conventional classroom.

The two-year-old system represents the school's latest step in a decade of experimenting with long-distance learning. It has allowed the school to continue offering German, entrepreneurship, even art - often crossing county lines and jurisdictions to do so.

"It's more fun" than a conventional class, says senior Leigh Johnson. "You see [these same] people sitting at basketball games" in the away bleachers.

But students and teachers agree the system doesn't quite live up to the live interaction of a traditional classroom. And, so far, the technology works best for highly motivated students, Smith adds.

Jim Long, chief executive of West River Health Services, knows all about crossing county and even state lines. He pulls out a map of his service area, which he calls his "huge potato" - a sprawling oval the size of West Virginia that spills over into South Dakota and Montana.

To reduce travel times for patients, the nonprofit center's 15 physicians and 10 nurse practitioners and physicians' assistants staff 11 part-time satellite locations outside Hettinger. And when critically ill patients face a two-hour ride to Hettinger in, say, a South Dakota ambulance service, the hospital on occasion sends its own ambulance to meet them halfway. Then, patients can get attention from a more highly trained paramedic before they reach the emergency room.

"We have always prided ourselves on being innovative and aggressive," Mr. Long says. But he is butting up against the same economic and demographic forces the rest of the Plains frontier faces. To keep a certain volume of business, he has to continue expanding his service area. Even then, its population is still declining. At its peak, West River delivered 300 babies a year. The current total has slipped to less than a third of that.

Besides economic and demographic forces, there's another problem. The federal government reimburses rural hospitals less generously for Medicare patients than it does urban hospitals. Two federal initiatives should reduce the difference. Still, the disparity crystallizes a widespread feeling among frontier communities that state and federal government haven't been of much help.

"Why make it more difficult to maintain the services in the rural areas, which only serves to depopulate them?" Long asks. "Rural America should not be forgotten and disposed of because it doesn't fit into the New York way of things."