Within academic and public policy discourses on the restructuring of welfare societies, decision makers now expect the voluntary sector to play an active and direct role in the provision of public services, particularly with respect to health and social care in the community. As governments at all levels continue to devolve and downsize, critical attention has been directed towards the diverse range of voluntary sector providers who are forced to bear an increasing share of responsibility for the direct delivery of services. The viability of the voluntary sector to take up this role, however, remains unclear. Such is the case, especially in the countryside, where the capacity to cope is most problematic.To address these issues, this thesis examines the relationship between public service restructuring and voluntarism as it relates to the delivery of health care services in rural and small town settings. Featuring a qualitative case study of three communities representing remote hinterland, rural hinterland and urban countryside settings, the research elucidates the changing role of non-profit and voluntary organisations, community groups and volunteers in the provision of long-term care in rural Ontario, Canada in the late 1990s and early 2000s. Thematic, policy and narrative analyses of primary data drawn from in-depth interviews with 72 key-informants and secondary data drawn from the literature, and government legislation, policies and documents provide a comprehensive explanation of how voluntary sector providers are struggling to reconcile the long-standing issues of service provision in rural areas with the downloading of responsibilities for direct service provision associated with public service restructuring.