In the health and welfare policy of the 21st century, the building of healthy communities in rural areas has become an urgent task. The working out of an effective strategy and supportive activities by the Japanese Association of Rural Medicine have become important. We analyzed the situation, outcome, and problems of the health projects which have been continued for the past 40-50 years in Takasu?cho in Hokkaido, Masuda-cho in Akita, Matsumoto City in Nagano and Izumo City in Shimane Prefectures. The supportive actions by hospitals and universities were assessed as a model of community-academia collaboration.