All of what’s proposed here, much like incentives to relocate families or Kyoto’s tourism problem, don’t look at underlying structural issues, the root cause, which, of course, is complex but boils down to the unfortunate fact that most rural areas have created for themselves by way of the status quo or have had created for them an image of patheticness, a an endlessly repeating spiral of self-defeat.

That’s not what some places actually are, but after so many years of convincing themselves of their podunk-ness, they’ve become rather podunk, assumed that role, and with that comes the whittling away of resources, doctors included. Like any tailspin, it’s hard to come back from - and some, probably many, won’t.

As much as I love Tohoku - I lived in Miyako on the coast of Iwate from 2009-2011, got wrecked by the tsunami there, still have very strong ties - its situation is mostly too far gone to make good use of the resources Japan is able to muster right now to address the issue.

As I do with akiya, there are easy wins, lost causes, and everything in between. What must be done in the short term to affect a more positive long term is to tactically determine those easy wins and achieve them one by one.