Funding for rural hospitals and healthcare is making headlines right now, shining a light on challenges that affect millions. In the U.S., about 1 in 5 people live in rural areas. That’s 60 million people, yet rural communities are sometimes left out of public health conversations.
I’ve lived in rural areas for almost 20 years, and I’m still learning about rural health needs and strengths. With this post, we’re kicking off a new series on rural health.
What does “rural” mean?
The U.S. government generally defines rural areas as places with fewer people, lower population density, and more distance from cities. The exact criteria vary by program: for example, a town may qualify for USDA rural housing loans but not for Medicare’s Rural Health Clinic designation.
Life Across Rural America
Rural life is diverse and goes far beyond the storybook image of red barns and rolling hills. There are rural areas in every landscape, climate, and U.S. state. People work in mining, manufacturing, tourism, farming, forestry, and many of the same professions found in cities. Some areas are thriving, while others struggle after losing jobs that once sustained them. Some towns have walkable main streets, while others are spread out, with homes far from neighbors or town centers. Despite these differences, rural communities share many of the same health challenges.
What Shapes Rural Health
Community health – whether rural, suburban, or urban – is shaped by our physical environment, systems, and culture. Healthcare is one piece, but in rural areas, distance, limited options, and poverty make many aspects of life harder.
Addressing 8 Rural Health Challenges
1. Higher Burden of Chronic Disease
Rural Americans face higher rates of heart disease, cancer, stroke, chronic respiratory disease, and diabetes—and often die younger. Limited access to prevention and specialty care delays diagnosis and makes chronic disease management harder.
💡 What can help:
- Telehealth programs that support people in taking medicines as prescribed, blood pressure control, nutrition, and follow-up care.
- Peer support groups and workshops that help people build skills, knowledge, and confidence to manage their health.
- Food and activity programs that expand access to healthy food and physical activity (e.g., CDC’s High Obesity Program).
CDC Telehealth Intervention Page
Rural Health Information Hub’s page on Chronic Disease
Preventing Chronic Diseases and Promoting Health in Rural Communities
2. Limited Healthcare Access & Emergency Response
Many rural counties have few healthcare options, sometimes without psychiatrists, primary care providers, or doctors who specialize in pregnancy, childbirth, and reproductive health. Telehealth helps, but in-person care is still needed for exams, wound care, prenatal ultrasounds, and other hands-on services. Long travel times for ambulances and first responders increase risks during medical emergencies of all kinds.
💡 What can help:
- Tele-obstetrics and tele-psychiatry for appointments that don’t need to be in person
- Policies allowing nurse practitioners, physician assistants, and other mid-level providers to see patients and prescribe medicine
- Community health workers connecting people to care, explaining health information in plain language, and supporting everyday health needs
- Mobile health clinics for essential checkups
- Loan forgiveness and residency programs to attract clinicians to rural areas
- Emergency response improvements: mutual aid agreements between neighboring communities, cross-training first responders, air transport for critical cases, better dispatch systems, and basic life-saving education for residents
CDC Preparedness Response Standards PDF
HRSA Rural Access to Emergency Medical Services PDF
Rural Health Information Hub Rural Healthcare Access
3. Outdoor and Indoor Environmental Exposures
Overall, rural residents are exposed more than people in other regions to pesticides, chemicals and heavy metals from mining and other industries, and contaminated, untested drinking water.
Indoor air quality is also a concern, as many households rely on wood heat. Native American and Tribal communities in rural areas are especially affected.
💡 What can help:
- Water safety: Regular testing of private wells for nitrates, arsenic, and bacteria; state and local testing programs, sometimes supported by CDC.
- Indoor air quality: Educational campaigns on reducing pollution from wood heating.
- Tribal communities: The newly created Indoor Air Quality Tribal Partners Program provides culturally specific resources and peer learning to reduce exposure.
Indoor Air Quality Tribal Partners Program (EPA)
Wood Smoke and Your Health (EPA)
Indoor Air Quality (IAQ)
Guidelines for Testing Well Water (CDC)
Protect Your Home’s Water (EPA)
4. Mental Health & Suicide
People in rural America face high stress, stigma, and isolation. Stress in rural areas is made worse by poverty and the lack of control that comes with jobs heavily affected by the weather. Limited resources and many of the other challenges noted in this post add to the strain. The National Rural Health Association points out that in rural communities, stigma around discussing mental health or seeking care makes it harder for people to get support and increases their risk. Older adults can become more isolated as they stop driving, a bigger challenge where cars are often essential.
Suicide rates are higher in rural areas than non-rural areas and increased faster over the last 20 years. Within rural areas, suicide rates are especially high for Native Americans, farmers, veterans, and LGBTQ+ people, particularly LGBTQ+ youth.
💡 What can help:
- Culturally tailored programs: farm-stress hotlines, peer support, and affinity groups for people at higher risk.
- Increased access to crisis lines and mobile support units.
- Community-building: low-cost/free gathering spaces, events, and local support groups to reduce isolation.
- School-based programming to support youth.
- Mental health and suicide risk screening in healthcare and schools.
- Public awareness campaigns to reduce stigma.
- Policy changes addressing risk factors, including gun safety, financial stress, mental healthcare access, and unemployment.
Suicide in Rural America (CDC)
Rural Suicide Prevention Toolkit (RHI Hub)
Rural Suicide Prevention Report (NY State Office of Mental Health)
National Institute on Minority Health and Health Disparities Research Framework
5. Substance Use & Overdose
In rural areas, opioid overdose death rates have been climbing and are now higher than in urban areas, and overdoses involving both opioids and stimulants are seen more often within several professions common to rural areas. Many rural communities also have high rates of alcohol-related health problems and cigarette smoking.
💡 What can help:
- Programs addressing mental health, stigma, and isolation to reduce substance misuse.
- Naloxone distribution and training for immediate opioid overdose response.
- Mobile syringe services to connect people to care and reduce infection risks.
- Cross-training local providers to ensure timely addiction treatment in small towns.
- Workforce incentives like the NHSC Substance Use Disorder Loan Repayment Program to recruit and retain treatment professionals.
- Mobile rapid response teams that respond to support affected families and children after fatal and non-fatal opioid overdoses.
Drug Overdose in Rural America as a Public Health Issue (CDC)
Rural Response to the Opioid Crisis (RHI hub)
Substance Use Disorder Workforce Loan Repayment Program
6. Transportation & Digital Divides
Public transit is limited, and spotty broadband can block access to telehealth, education, and jobs. Although more federal and state funding is needed for comprehensive improvements to both transportation and internet access, other solutions can also make a difference.
💡 What can help:
- Expanding high-speed internet service using data on where coverage is missing and regulating broadband as a utility to improve access.
- Increasing hours and locations of sites that offer public internet service, like libraries.
- Public WiFi in rural town centers.
- Transportation solutions like microtransit, on-demand rides, connector services, volunteer rides, rideshares, car repair programs, and other local approaches.
Broadband Resources for Regional Development Organizations
Rural Transportation Toolkit (RHI hub)
7. Limited Choices for Goods and Services
Accessing needed resources in rural areas is often about more than distance. Options may be limited, seasonal, or more expensive due to low competition.
💡What can help:
- Mobile services: Clinics, libraries, and grocery trucks that bring goods and care directly to remote areas.
- Incentives for local businesses: Grants, tax breaks, or technical support to help small stores, pharmacies, and service providers operate sustainably.
- Cooperative models: Community-supported agriculture (CSA), food co-ops, and shared childcare networks that pool resources and staff.
Rural Hunger and Access to Healthy Food – Strategies (RHI hub)
Early Education Shared Service Network Example (RHI hub)
8. Unintentional Injuries
Unintentional injuries are a major rural health concern, worsened by longer emergency response times. About 40% of all fatal motor vehicle crashes in the U.S. occur in rural areas, even though only 20% of Americans live there. Jobs like farming, ranching, and forestry carry high risks for injuries, and home or outdoor injuries are also more common.
💡What can help:
- Motor vehicle safety: Better road lighting and signage, seat belt and carseat education, programs to reduce distracted and impaired driving.
- Worker safety: Training in safe equipment use and protective gear.
- Other safety measures: ATV and chainsaw safety, fall prevention for older adults, and child water safety education.
Rural Unintentional Injury Prevention Toolkit
Agricultural and Farm Safety – NIFA/USDA
Rural Road Safety (USDOT)
There are many more challenges that rural residents and public health agencies are working to address: climate vulnerability, the needs of aging community members, housing shortages and quality, and heightened risks for people in abusive relationships, to name a few. If you’d like to see a deeper dive in a future post on one of these rural health challenges or on another rural health topic we didn’t have room for, we’d love to hear from you!
Stay well, stay connected.
Love, Those Nerdy Girls+
