Housing in Old Town reflects its rural, unincorporated character. Buyers find modest single-family homes on larger lots, mobile homes, and scattered acreage, along with riverfront properties prized for Suwannee River access. There are no large planned subdivisions; instead, homesites spread along U.S. 19, State Road 349, and the county roads that wind toward the river. Inventory is limited, and the market blends permanent residents with recreational and weekend buyers seeking a quiet Nature Coast retreat. Properties tend to emphasize land and privacy more than dense residential amenities.

Old Town has no formal subdivision structure; it is a dispersed rural settlement organized around the U.S. 19 and State Road 349 crossroads and the Suwannee River shoreline. Residential properties string along the main roads and unpaved county lanes, with riverfront parcels forming the community's most desirable addresses. The nearby community of Suwannee, connected by County Road 349, functions as the river's Gulf-side fishing village. This scattered layout gives Old Town a quiet, spacious feel, with neighbors often separated by woods and pasture rather than fencelines.

Life in Old Town is slow, rural, and closely tied to the Suwannee River and the surrounding forest. The community is small and close-knit, with a pace shaped by fishing seasons, river levels, and the rhythms of the Nature Coast. Daily errands often require a drive along U.S. 19 to Cross City, the county seat, or to larger towns such as Chiefland and Fanning Springs. Residents value space, quiet, and access to water and woods over commercial convenience, and the area retains an authentic old-Florida character distinct from the state's more developed coastal corridors.

Old Town is served by the Dixie County School District. The community's youngest students attend Old Town Elementary School, with Ruth Rains Upper Elementary covering the intermediate grades, and older students moving on to Dixie County Middle-High School, whose athletic teams are the Bears. The district is small and rural, serving the whole of sparsely populated Dixie County, so families should expect a limited set of campuses and programs compared with larger Florida districts, balanced by small class sizes and close community ties.

U.S. Highway 19 is Old Town's principal road, running north toward Perry and south toward Chiefland and the Gulf Coast, while State Road 349 leads southwest to the fishing community of Suwannee. There is no public transit, and private vehicles are essential for daily life. Cross City, the Dixie County seat, is a short drive south on U.S. 19, and Gainesville lies roughly an hour to the northeast, providing the nearest regional airport, hospital systems, and larger employment markets. The rural two-lane character of the roads keeps travel unhurried and traffic light.

The Suwannee River is the center of recreation in Old Town, offering freshwater fishing, boating, and riverside access, with the Gulf of Mexico reachable downstream at the fishing village of Suwannee. The springs of the Nature Coast lie nearby, including Fanning Springs State Park and Manatee Springs State Park, both known for swimming, paddling, and manatee viewing in season. The surrounding Dixie County woodlands support hunting, hiking, and wildlife watching, and the submerged City of Hawkinsville steamboat is a noted underwater landmark for divers and history enthusiasts.