I recently started a non-accredited PM&R fellowship at a private practice. It looks like I will learn a lot and get a great deal of experience, as the practice has a pretty sophisticated practice and is swamped and they are willing to allow me to jump in early. However, I have heard that competitive post-fellowship jobs in metropolitan areas usually require ACGME-accredation. Is this true? My concern is that the only options left to me will be in rural and far-flung places. If that's the case, what can I do to better my position?