Abstract: The scale structure of villages and towns and their spatial organization is an important topic of spatial research in rural areas, and it is also an important technique issue of township territorial spatial planning. However, the existing research lacks a systematic review of the evaluation indicators of villages and towns' scale and spatial organization efficiency, and the understanding of their internal connectivity is not explored enough. Besides, there is a lack of scientific understanding of the internal driving force of the economic and social development. Based on the connotation of spatial organization efficiency, this paper constructs a scale structure and spatial organization efficiency evaluation system of villages and towns in county areas, taking Guangrao County, Shandong as the research case of plain areas and Renhuai City, Guizhou of mountain areas. The study found that mountain villages and towns are more sensitive to ecology. Whether in plain or mountainous areas, the 'scale structure-economic and social fit degree' is better than the 'scale structure-ecology fit degree' in the county town. The 'scale structure economic and social fit degree' and the 'scale structure-ecology fit degree' of plain villages and towns explain the development level of villages and towns more significantly than that of mountainous areas, and the effect of the relevant indicators on the development level of mountainous villages and towns is more complex. Therefore, the study suggests that mountainous villages and towns should pay more attention to the appreciation of the village and township scale, with particular emphasis on adapting measures to local conditions to achieve a development model that is compatible with the ecological, economic and social development of the village and township in the region.