Residents living in the rural shire counties have little or no access to GP services, according to new research.
Herefordshire has the poorest GP provision in the country, with 81 per cent of hamlets and villages having access to only one GP within five kilometres of their homes.
Figures released by the Commission for Rural Communities found just 19 per cent of people in Herefordshire villages could register with two or more GPs, compared to an average of 52 per cent across England.
In Shropshire almost 80 per cent of villages have access to only one GP within five kilometres of their homes, the CRC said.
Rural communities also have little choice when it comes to secondary schools, with only one-third (33 per cent) of people living in villages having the choice of more than one secondary school within five kilometres of their home.
Liz Flood, of the CRC in the West Midlands, said the figures presented stark evidence of the lack of choice for many people living in rural England at a time when the Government was promoting choice and competition in its reforms of health and education.
"The message is if people have only got one service then we need to look at how Government introducing choice as a means of improving competition will help these areas," Ms Flood said.
"The other issue is secondary education. Schools in rural areas tend to be used by the local community for many things and if competition could potentially cause a risk of closure then the knock-on effects would be far greater than it would if there was another school down the road."
A reform of public services and encouraging choice will bring changes to the way services are designed. Rural areas present particular challenges for choice policies, the commission said.
These include access to transport, the additional costs of service provision in sparsely populated areas, and whether the private sector wants to provide public services in areas where economies of scale are less.
Many existing providers of public services in rural areas struggle with these issues and the commission's report found accessibility problems for those living in sparsely populated rural areas.
Rev Nick Read, agricultural chaplain for the Hereford Diocese and chairman of the Institute of Rural Health, said: "The Government wants us to be able to choose which hospital we want but in areas like Herefordshire that is absolute nonsense. There is a feeling that what might work in urban areas might work in rural areas but this is not the case."
The commission is to carry out more research to assess whether the benefits of choosing the best services will reach rural people and communities, and identify ways in which they might work more effectively in rural areas.
Professor Sheena Asthana, board member on the commission, said: "As greater choice is promoted for users of public services, including many aspects of healthcare, there is an urgent need to understand how this will work in rural areas.
"Policies must be tailored to meet rural, as well as urban, circumstances if rural communities are to benefit.
" There is a wealth of research, reports and commentaries on the choice agenda. However, even where rural delivery has been highlighted as a difficult area, there has been no progress on this matter.
"This commission study will endeavour to break important new ground and we hope that other organisations will want to contribute their knowledge, experience and ideas."
The study will take an overview of the issues for users and providers of services, and will look in more detail at choice policies for secondary schools and healthcare.
The commission will be gathering evidence and commissioning research to inform its analysis.
The study will be completed next summer with the aim of influencing policies and their local implementation.