I'm a radiologist in a rural critical access hospital. We have 25 beds (+ some 'observation stretchers) and a regular medical staff of about 16 (10FP, 3IM, 2GS, 1rad) and some orthopods, opthos, GI and uros that come on a monthly basis. The town has about 1800 locals but the hospital serves a rural catchment area of about 25k year around (60k in summer).
Our 2 GS run very different practices. One is a maniac with a very busy bariatric practice and is probably atypical for a community this size. The other one is a classic small-town surgeon who limits his elective cases on anything that doesn't have a potential to get him called back at night. He does plenty of colonoscopies, EGDs, breast work, central lines, ports, hernias, lap-choles ingrown toe-nails etc.
It is actually the small fry that seems to make the best money in GS. That big tumor operation that costs you hours to do and ties you up for hours in follow-up pays less than if you had spent the same time removing ingrown toe-nails (derms have figured that one out, freeze a wart here and shave a mole there and you can make that next boat payment).
A problem in rural communities is the high proportion of 'goverment work' and plain unpaid. Being a ranch-hand doesn't pay so well, so you are likely to see plenty of self-pay and most of the kids on medicaid or SCHIP.
I second the recommendation not to buy a big-azz house. It will be a millstone around your neck if that great opportunity doesn't turn out to be so great. I suggest not to buy a house at all if you can help it for the first year or two. If you go out on your own (e.g. with a recruitment loan from the hospital), your first years taxable income won't be that high and the tax benefit is low. After a year or two you will be able to tell whether this is a long-term proposition and by then you will have a good idea about where to build and who to hire (chances are, all the local builders or tradespeople had 'work done' by you at that point).
By the way. If you are a department of one, JCAHO doesn't require the hospital to put you on-call or to provide call coverage. While it would be your best business interest to be available, you can legally arrange your practice in a way that you are not on-call q1. Oh, and don't think call is the same as at your academic teaching institutions. In the community, nursing actually has the capability to follow orders, take phone orders and discern the important from the stuff that doesn't need immediate attention. At least in our situation, an after-hours appy doesn't come to the surgeons attention until CT and bloodwork are done, an admission H&P has been entered in the chart by the on-call FP and the OR staff is on their way in.
If you contemplate this, make sure the hospital has the OR facilities, equipment and staffing you need to get your job done. If not, get a budget and a staffing committment put into your recruitment contract. I am not a surgeon, but if that 30 year old monopolar cautery they have rusting away there is not sufficient, you don't want to have to argue with the hospital CEO on whether they can get it in the budget 4 or 5 years from now.
The service area you are describing sounds a bit smallish to support a GS. There might be other hospitals in the area that need GS coverage. In our area, we have some surgeons who do itinerant work. It is a bit scary because you have to enter into follow-up agreements with the local PCPs and you won't be able to do anything substantial if you know you will be 80 miles away at 10 pm when the patient hits the ER bleeding. So this kind of work has be very limited to the cheap and cheerful stuff. One of our GS goes to a smaller place and cranks out a day of colonoscopies and breast biopsies every other week.
Oh, and make sure you know whose turf you are infringing upon. The surgeon one town over might be quite happy about the referral stream he gets from this community. Also, the local docs have an established referral pattern, don't expect that just because you are there, people will automatically refer to you.
