Lipscomb County, population 3,302 as of 2010, in the northeast corner of the Texas panhandle, doesn’t have a doctor. It is worth noting that Lipscomb County is a 550-mile drive from Austin. Portland, Maine, is a closer drive to Washington, D.C., than those 3,302 isolated souls.

Given this isolation and lack of resources, the vaccines themselves present a logistical challenge alone that borders on the impossible for rural America. The Pfizer vaccine, now the leading contender, will require ultra-cold storage of at least -94 degrees Fahrenheit and two rounds of shots. Another leading vaccine candidate from Moderna also requires ultra-cold storage. Typically, hospitals and large clinics have this capability. Small towns lacking even the most basic health clinics do not.

To deploy the Pfizer vaccine or any other one, health planners will have to figure out a way to deliver it to rural areas while maintaining its required temperature long enough to ensure that the population receives both doses. This scene will be repeated all across small-town America. This presents a big risk: An uncoordinated federal roll out of vaccines requiring ultra-cold storage could leave state and local governments competing for resources much like they were competing for PPE earlier in the pandemic.

Trump has indicated that the military will be the savior here, but the military has its limits.