We live in a very small town, and I have to say that quality childcare has not been an issue. I have found my providers by word of mouth. Our two oldest attend a nursery school which is literally a 5 minute walk from our house and a 2 min drive from my husband's office (one of the benefits of such a small town I guess ). Our youngest goes to an in-home daycare provider (unlicenced) who is wonderful. She and her husband have four boys (12, 9, 6 and 2) and they are just the nicest and most well-behaved kids I have ever met so I guess that gave me a good feeling about her. She is also someone who has a similar background to me but who has chosen to stay home with her kids and is much more patient with kids.
Having the kids so close to my husband's workplace has been ideal since I attend school about a 45 min drive away. I find that both the nursery school and the in-home provider are very flexible and let me switch days, extend hours etc at very last minute notice. This has worked out incredibly well for us and has helped quell the "worrier" in me.....hehe (see my other post).
Childcare is expensive though! Last year we had 3 in care part-time, and this coming year our oldest goes to real school, so we will have 2 in care but on a more full-time basis.
I would suggest for anyone looking for the "right" childcare situation, ask EVERYONE you meet who has children, and you are almost guaranteed to find something that works for you. Word of mouth, especially from mothers that have past experience with a provider, is I think the best way to go. If you are new to an area, check out some local Mom's and Tot's groups, and just ask everyone there who they use or know about.
Oh ya, one other thing. When checking out providers, I visited several, and observed the interactions between kids and providers. The nursery school I chose was the least "flashy" in terms of facilities and playground equipment, but the number of children is quite small, and the staff is just wonderful. You can tell that they really love children. I have had the experience of picking up my children one afternoon and finding out that one of them had been feeling a little under the weather all day (nothing serious). One of the teachers had spent most of the afternoon just holding him in her lap, cuddling him and giving him extra attention! You just don't get that kind of care at some of the bigger and busier centers - they just call the parent at the first sign of illness, even when it really is nothing serious.
My daughter is currently enrolled in an education center/daycare. It is a smaller school and it's not well known like the bigger ones. There aren't that many children and I thought it was just wonderful having such a balanced teacher to child ratio. When my daughter was alot younger, I had sent her to a bigger school (kinda like a chain school) and I wasn't pleased with the care that they provided for my daughter. Several times, when I picked my daughter up from school, she had "snot" all over her face (eewww) from crying and the teachers didn't even bother to wipe it off. There were far too many children, with not enough teachers to provide the attention that they need. So I pulled my daughter out after a week and a half.
Not to mention that many of the smaller schools are not as expensive. The one my daughter attends is a little over half of what the other school was. The bigger school did not provide meals and had worse care, but it was $800/mo. full-time. The one she attends now is $450/mo full-time and they provide 3 nutritious meals.
I feel like this school is a God-send. The only problem is, it's an hour away from where I live. Now, I need to decide whether I'll keep her there. My daughter will be very sad to go, and so will her teachers.
I too faced the childcare issue when I came to med school (3+ years ago!) in a strange town with no family or friends. The office personnel had many suggestions, and I visited numerous preschools, as my son was 4. The school I liked the best was just like a previous post. Not flashy at all. It was in an older building attached to a church. Although not new, it was filled with children's art, clean and friendly. Most of the toys were well used, but plenty to go around. Childcare around here ranges from $75-120 depending on age and facility. It was $85/wk for James.
He had a fantastic preschool year, and still attends there in summer (2nd grade now). I urge folks looking for childcare not to immediately disregard a place if it's not new, or filled with new toys.
I was looking forward to less expense with school, but my rental house is out of city limits, and county schools are just horrible here so he has been at the catholic school since K. It is FANTASTIC! We're not catholic, but it has never been a problem. The academics are fantastic, with Spanish beginning in K, and there is a true sense of family there. Non-catholic tuition was pretty stiff (around $400/mo), but I spoke with the priest about my desire for my son to attend there and while no scholarships are avail for non-catholic students, he offered to let James attend for catholic tuition. I perused the religion texts and found nothing even remotely negative about other religions, and no talk of "bad kids go to hell." It has been an incredibly positive experience. While I hope to be able to get a good public school for him during residency, I will always keep the catholic schools in mind. It's been worth every penny.