[taterchips]

First post (sorry...it's a wordy one), so be nice please

I have been running Adwords advertising since 2005. I run a healthcare clinic and Adwords has been a great source of business. Since that time, I have generally appeared in the top 2 or 3 of the Sponsored Links section. Since the beginning of the year, I've dropped to the 4/5 position way over on the right side of the screen. You know, the area that no one really pays attention to.

I'll admit, I've been bad and haven't kept up on new tools, info, updates, etc., and now I think I'm paying for it (literally).

So, I've done a bunch of reading and feel more confused and frustrated than ever. I feel like just flushing my campaigns and starting all over the right way, and need some help.

Since I run a clinic that caters to the local community, with no e-commerce, I'm really only interested in customers within a 20-25 mile radius. I am currently running a locally targeted campaign, as well as a general campaign. If I never had a visitor/click from outside that area, I would be extremely happy.

Some history:

The local campaign is targeted to the area within 25 miles. I have 4 keywords, search network only, with a click through rate of less than 1% on all. Keyword analysis for all gives the message: The Ads Diagnostic Tool "quick test" does not work in this campaign because the campaign's geographic targeting is not supported

Regional campaign has 2 adgroups, each targeting one of each of the 2 main cities that I cater to (within 20 miles). Each adgroup has ~20 words/phrases, equally split between exact match, phrase match and broad match. Quality score ranges between 4-7/10, but mosltly 6s and 7s. CLick through rate ranges from .5% to 6 and 7%. Some of the phrase match don't display during searches because exact match already covers the bases. And exact match has a better click through rate.

So, where do I start? Should I stick with a locally tagerted campaign only? Should I stick to the regional campaign and ditch poorly performing keywords (low click through and poor quality score)? If I have a logical starting point I can settle down and get to the business of fixing things. Or, should I scrap things and start over? I've read that poorly performing adgroups/campaigns/keywords can affect overall adwords performance. I've also read that I should be running many small campaigns and adgroups. Sooooo confused.

BTW, I know EXACTLY who my competition is if that's helpful. In my field there isn't that much competition, but enough who know what they're doing to relegate me to Tumbleweedville on the right side of the search results screen.

Thanks for your help (and for your patience).