The development of managed care programs has allowed children who are medically fragile and technology-dependent to be discharged back to their home communities. Rural and urban settings each have unique characteristics that can affect home care. A number of home-care problems are common to both urban and rural settings, including nursing coverage, respite care, school services, coordination of medical resources, and emergency response protocols. Although the problems may be similar, the solutions often differ and should be adapted to the unique urban or rural settings in which they occur. Approaches to these problems are offered on the basis of experience in providing care management to these children in the Specialized Home Care Program in Michigan. Also explored are the problems of and lack of resources available to children who are medically fragile but not technology-dependent.