Data from the National Medical Care Expenditure Survey were used to examine access to care and utilization of health services in federally designated health manpower shortage areas (HMSAs). It was confirmed that residents of shortage areas experience some deprivation in access to care and use of services. Further analysis, however, indicated that shortage area designation has little direct effect on indicators of access and use. Factors such as income and health insurance coverage appear to be more closely associated with access and use than is an area's designation as a HMSA. The assumptions concerning access to care in federally designated shortage areas should therefore be reexamined.