Young people with complex support needs who live outside metropolitan areas face unique challenges. Issues such as poor educational and employment opportunities, homelessness, racism, problematic substance use, challenging behaviour, disability and mental illness can be magnified and lead to judgment and marginalisation in small communities such as those in rural and regional areas. As a result of poor resourcing of services in these areas, young people may be forced to transition from place to place, service to service as a way of coping with life challenges. This paper presents findings from interviews and focus groups with service providers who support such young people in regional and rural Queensland, New South Wales and Victoria in Australia. Service providers reported similar challenges to professionals working in urban areas, such as navigating inter-agency and inter-professional work and dealing with funding shortages. However, these issues were amplified by the need to work across broad geographical areas, to recruit and retain skilled workers and to respond to the many structural and resource inadequacies in smaller communities. While services aimed to be responsive to young people, the challenges of providing support in a non-metropolitan context could create a context in which young people either disengaged from services or poor response resulted in systemic escalation to crisis. The implications for policy and practice are explored.