People living in many of the rural areas of the North-East are still missing out on the range of key services that their urban neighbours enjoy.
Although some country areas actually fare better than the towns, the majority miss out on social and leisure facilities as well as on basic services.
And the latest regional State of the Countryside report highlights the importance of rethinking the role of many rural activities to redress the balance.
The report is the third to be issued by the Countryside Agency and it follows the publication of the North-East's Rural Action Plan, which pledged local authorities to put rural affairs at the heart of policy-making.
The agency's regional director Keith Buchanan said: "Much of the region's population doesn't live in urban centres and it is vital that the policies and strategies we develop fully recognise the needs of our fast-changing countryside.
"There are huge decisions to be made if we are to bring about the changes that will ensure a lasting revival of our rural economy."
The report also reinforces concerns that the region's rural economy is performing weakly compared with other parts of the country.
Agency board member Professor Philip Lowe said: "Our region has the highest level of rural unemployment and one of the least qualified workforces in England.
"We also have the lowest proportion of rural businesses per 10,000 population compared to other regions and significantly lower internet use outside main urban centres."
He added: "The Government's new commitment to raise the productivity of the lowest performing rural districts is therefore welcome news which needs to be followed through with practical action and investment in the rural North-East."
However the report also illustrates that changes can be made and highlights. Among other things, the Market Towns Initiative, developed in partnership with the regional development agency One NorthEast.
Based on community health checks' and in-depth local consultations, 13 towns - Alnwick, Barnard Castle, Berwick-upon-Tweed, Crook, Guisborough, Haltwhistle, Hexham, Middleton-in-Teesdale, Morpeth, Rothbury, Seahouses, Stanhope and Wooler - have developed three-year action plans.
Most have now appointed town centre managers or similar posts to drive forward projects designed to bring about practical change.
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