This paper examines the regulatory status in the aviation industry, and the efforts of the U.S.A., Canada, Portugal, Spain and Brazil to adopt air transport policies and mechanisms to provide their populations with universal accessibility. A systems engineering grounded theory approach and a cross-national case-based comparison framework are used to look at the impacts of different policies and mechanisms on the air service to small remote communities. It is found that the success of a policy design critically depends on five factors: 1) the joint support of infrastructure investment, maintenance and operations and air services; 2) governments’ ability to promote competition and protect passengers in markets where competition does not exist; 3) the operating carrier’s choice of business model, technology for thin routes, and network; 4) political interest; and 5) local participation. Based on the evaluation of policy designs and assessment of policies in five substantially different national contexts and interviews with several stakeholders, the authors provide insights and suggest recommendations in small remote air transport policy for policy makers and practitioners. The recommendations are applicable to other countries reforming their aviation industries.