The view that people who live in the countryside are rich and enjoy a rural idyll masks pockets of deprivation and poor health, according to a new report.
The study, from the Local Government Association (LGA) and Public Health England (PHE), says people living in rural areas face serious barriers to ensuring good health and avoiding social isolation.
There are scant official statistics on the health of all people living in the countryside, while the pervading view tends to be that people are wealthy, it said.
But this hides the fact there is "real hardship" in some regions, including Cumbrian coastal areas, small seaside towns with a "bedsit economy", former mining communities and areas where there is a high degree of seasonal work, the report said.
Almost one in seven rural households live in relative poverty after housing costs are taken into account, while more rural households experience fuel poverty than urban ones.
Poorer public transport links also have a "significant impact" on people's daily lives and access to services, the study said.
"Rural areas have worse access in terms of distance to health, public health and care services.
"Longer distances to GPs, dentists, hospitals and other health facilities mean that rural residents can experience 'distance decay' where service use decreases with increasing distance."
Some 20 per cent of rural dwellers live more than 2.5 miles from a GP surgery, compared with two per cent of people in urban areas.
Meanwhile, 45 per cent live more than five miles from a hospital, compared with just three per cent in urban areas.
The older population and the unavailability of high speed broadband and mobile phone networks is also leading to an "increasing digital gap between urban and rural areas", the report went on. This affects access to jobs and online health services.
Other risks to health identified by the report include increasing traffic pollution in rural areas where levels of ozone are generally higher.
People are also increasingly experiencing social isolation and loneliness, especially among older people, which affects their health.
The costs of delivering social care, such as help with daily tasks, to rural locations is also higher than in cities and towns.
Izzi Seccombe, chairwoman of the LGA's community wellbeing board, said: "We often think of rural areas as picture-postcard scenes of rolling green fields and farming land, yet this idyllic image is masking pockets of deprivation and poor health.
"Although many rural areas are affluent, this is not the case for everywhere. The north/south divide can be seen in the countryside as well as the cities. And within even the wealthiest rural areas, there are pockets of real hardship, ill health and inequalities.
"Rural communities are also increasingly older, and older people often experience worse health and have greater need of health and care services.
"We are also concerned that the make-do attitude and reluctance to make a fuss of some older rural residents means they may not seek out health care or treatment when they need it.
"This stores up worse problems for later on where they require far more serious and emergency care."
A Government spokesman said: "We want everyone to get high quality health care regardless of where they live.
"That's why we have given £16 billion to local authorities so they can make sure the right public health services are in place to meet the needs of their communities, as well as taking action to make sure everyone can get access to a GP.
"We are working to deliver an estimated 5,000 extra GPs by 2020 and targeting recruitment to the areas that need them most."