I don't know what's available in rural Ohio, but I'm in sorta-rural southeast Washington and we're using a fixed-wireless Internet service provided by our local electric co-op. There's a router/antenna thing bolted to the side of the house, aimed at a transceiver 2 miles away. It's satisfactory for our needs, but city folk would consider it very slow and very expensive. We're paying $60/month for 4 MBPS download and 0.5 MBPS upload. At least there's no monthly data usage cap.
I think that's the only broad(ish)-band service available in my area, other than satellite or cell.
My wife has used it successfully with her corporate VPN, but with occasional glitches. She hasn't tried Skype yet -- it's been easier to just set up call-forwarding from her office phone to her cellphone for voice calls and teleconferences.