I read your question as if you were asking about starting a practice in the country, and then I reread it and realized you might not care about whether you're working for someone else or not. Well, I'm gonna go ahead and just leave my initial response since I spent a few minutes typing it:
I'm a medical student, but I have asked this question several times to family physicians. Even the "old timers" I spoke with who had started their own practices back in the day were contemplating selling their practice to a large hospital system so they didn't have to deal with the business side of things anymore. Starting out on your own in a small town and hiring a staff to do your billing, labs, front desk work, etc. has a modern day cost that is prohibitive. The reason is that it takes too much staff to handle all the paperwork. For example, the rural doc I shadowed this summer had one partner, 2 NP's, 1 nurse, at least five MA's, several front desk people, and an office manager. That's a ton of salary overhead, even without the NP's or office manager.
Let's say that you want to do a low-overhead type of practice. The options are essentially opening a direct primary care practice that is cash-only, a concierge practice of a similar but more expensive nature, or having a hybrid of direct and typical practice. These arrangements cut out the overhead because they take cash and don't deal with insurance and medicare, so there's often few employees per physician. The physicians often take fewer patients, depending on the model, and utilize a membership-based payment system to ensure financial stability. If you choose to do this, you need to find people willing to pay monthly for your fees, and truly rural areas simply don't have that kind of cash. Yes, you can google examples of people who have done it, but it's very difficult to do in a rural area.
Despite my saying this, I also would love to practice in a rural setting, and I'm trying to investigate some good ways to do it.