Cities without Suburbs is based on David Rusks experience as mayor of Albuquerque, New Mexico and member of the New Mexico state legislature. In this book, he uses detailed census analysis to show that the most economically robust cities are elastic. That is, cities that can capture their suburbs in a regional government, and with that, their tax base, have lower poverty and crime, better education systems and a better fiscal outlook. Cities that are "inelastic" lose their population growth to the suburbs and tend to be less fiscally stable and more racially segregated, as well as more impoverished than elastic cities. Examples include Detroit, Cleveland, Louisville and Milwaukee. Rusk argues that elastic cities are more successful because they practice some form of regionalism.

In addressing the practical side of implementing regionalism, Rusk contends that restructuring local governments is not a task for the federal government. Rather, it is a responsibility of citizens and political leaders at the local and state levels. He examines the mechanisms and politics of creating what he calls metro governments, and presents three specific options for the creation of metro governments:

1.  Empowering Urban Counties

The most direct and efficient way to create metropolitan government in the majority of metro areas is to empower urban county government. In this scenario, the county government assumes the functions and responsibilities of the municipal governments within its boundaries, and municipalities are abolished.

2. Consolidating Cities and Counties

This involves creating area-wide governmental units, focusing on consolidating municipal governments with their surrounding county governments. Consolidation brings unification of the tax base and centralization of planning and zoning.

3. Combining Counties into Regional Governments

This involves combining several counties in the same metropolitan area into one regional government.

Challenges to these regional approaches include potential loss of power at the local level.  Minority constituencies may have less voice in the issues affecting them directly. Also, different municipalities may have different problems depending on their history, geographic location and economic capacities.