We utilize a Managed Exchange Server from Rackspace.com and have encountered some issues with regards to the stability and performance of Public Folder HelpDesk.

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Problem Type : General
Problem Category : Exchange Server

PF Helpdesk is primarily designed as a workgroup collaborative application within a LAN environment. Nevertheless, the same application works on a WAN/VPN/remote/Citrix environments, but we can't say it will work as expected all the time under such conditions.

Regarding using a third party managed exchange server, that should work fine, but again performance depends on the connectivity.
 
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