In Visual Studio 2008 server explorer I see the Access database fine. I can view tables and data and I can even update the data. But I can't add new tables. Does VS 2008 not allow me to do this? Or is the security not right?
I don't think you can do it in VS. You can open the .MDB inside MS Access and do the regular table / query creation. Do you have MS Access installed?
I don't think that MS added support and put a lot of work into anything except sql server integration, for obvious marketing reasons :( They have let access languish for a while as well. You can add a MySql ole source, or oracle, but that will just read the same as access. Since DDL is even more custom that queries, I doubt they hand coded support for those, like the did for sql server.
That means, if you don't have access installed, you are probably stuck using text queries executed against the database. Think of access like a SQL Lite database: unless you install a real management UI, you pretty much are left with straight DDL.