Rural Health Needs in America: Challenges & Solutions

INTRODUCTION SECTION

In the United States, roughly 1 in 5 people live in rural areas: US Census Bureau, One in Five Americans Live in Rural Areas, 2017

Although just 3% of US land is urban, it houses 80% of the population, while the remaining 97% of the US is rural, with only 20% of people living there: US Census Bureau, One in Five Americans Live in Rural Areas, 2017

The percentage of individuals living in rural areas varies by state: US Census Bureau, American Community Survey, 1-Year Dataset, 2023

Rural communities have more older adults and individuals with chronic illness, contributing to greater health challenges and a higher risk of death: Centers for Disease Control and Prevention, Rural Health, About Rural Health, 2024

80% of rural Americans are medically underserved: Blue Cross Blue Shield Association, Creating a more equitable system for the health of America, 2024 

HEALTH OUTCOMES

Numerous demographic, environmental, economic, and social factors may place rural residents at higher risk for worse health outcomes. Contributing factors include limited health care access and higher rates of smoking, obesity, physical inactivity, and poverty: Centers for Disease Control and Prevention, Rural Health, Leading Causes of Death in Rural America, 2024

Rural residents also face higher death rates for several chronic diseases–heart disease, cancer, stroke–as well as unintentional injuries and suicide: Centers for Disease Control and Prevention, Rural Health, About Rural Health, 2024

Crude mortality rate per 100,000 people, 2021:

• Heart Disease Mortality, Crude Rate per 100,000: Centers for Disease Control and Prevention, CDC Wonder, About Underlying Causes of Death, 2018 - 2023, Single Race, 2025
  • NOTE: This source uses 2021, the last available year of crude mortality data. Data was pulled using ICD-10 Codes: I00-I09, I11, I13, and I20-I51. According to the Centers for Disease Control and Prevention, heart disease mortality is the number of deaths and age-adjusted death rates from diseases of the heart. Breakdown: I00-I02 (Acute rheumatic fever); I05-I09 (Chronic rheumatic heart diseases); I11.0 (Hypertensive heart disease with (congestive) heart failure); I11.9 (Hypertensive heart disease without (congestive) heart failure); I13.0 (Hypertensive heart and renal disease with (congestive) heart failure); I13.1 (Hypertensive heart and renal disease with renal failure); I13.2 (Hypertensive heart and renal disease with both (congestive) heart failure and renal failure); I13.9 (Hypertensive heart and renal disease, unspecified); I20-I25 (Ischaemic heart diseases); I26-I28 (Pulmonary heart disease and diseases of pulmonary circulation); I30-I51 (Other forms of heart disease).
• Cancer Mortality, Crude Rate per 100,000: Centers for Disease Control and Prevention, CDC Wonder, About Underlying Causes of Death, 2018 - 2023, Single Race, 2025
  • NOTE: This source uses 2021, the last available year of crude mortality data. Data was pulled using ICD-10 Codes: C00-C97 (Malignant neoplasms). According to the Centers for Disease Control and Prevention, cancer mortality is the number of deaths and age-adjusted death rates from malignant neoplasms.
• Stroke Mortality, Crude Rate per 100,000: Centers for Disease Control and Prevention, CDC Wonder, About Underlying Causes of Death, 2018 - 2023, Single Race, 2025
  • NOTE: This source uses 2021, the last available year of crude mortality data. Data was pulled using ICD-10 Codes: I60-I69 (Cerebrovascular diseases). According to the Centers for Disease Control and Prevention, stroke mortality is the number of deaths and age-adjusted death rates from cerebrovascular disease.
• Unintentional Injury Mortality, Crude Rate per 100,000: Centers for Disease Control and Prevention, CDC Wonder, About Underlying Causes of Death, 2018 - 2023, Single Race, 2025
  • NOTE: This source uses 2021, the last available year of crude mortality data. Data was pulled using ICD-10 Codes: V01-V99, W00-X59. Breakdown: V01-V99 (Transport accidents); W00-X59 (Other external causes of accidental injury); Y85.0 (Sequelae of motor-vehicle accident); Y85.9 (Sequelae of other and unspecified transport accidents); Y86 (Sequelae of other accidents).
• Suicide Mortality, Crude Rate per 100,000: Centers for Disease Control and Prevention, CDC Wonder, About Underlying Causes of Death, 2018 - 2023, Single Race, 2025
  • NOTE: This source uses 2021, the last available year of crude mortality data. Data was pulled using ICD-10 codes: U03, X60-X84, X87. Breakdown: U03.0 (Terrorism involving explosions and fragments); U03.9 (Terrorism by other and unspecified means); X60-X84 (Intentional self-harm); Y87.0 (Sequelae of intentional self-harm); Y87.1 (Sequelae of assault); Y87.2 (Sequelae of events of undetermined intent).

They also face increased risks of infant mortality and pregnancy-related deaths. Infant mortality is 27% higher in rural areas than in large metro counties.

• Source 1: Centers for Disease Control and Prevention, Maternal Mortality Prevention, Data from the Pregnancy Mortality Surveillance System, 2025
• Source 2: Danielle M. Ely, Centers for Disease Control and Prevention, National Centers for Health Statistics, Trends and Differences in Infant Mortality Rates in Rural and Metropolitan Counties in the United States, 2021-2023, 2025

Urban areas have higher overall drug overdose deaths. Yet, rural areas have higher death rates from some drugs, like methamphetamine, hydrocodone, and oxycodone.

• Source 1: Rural Health Information Hub, Substance Use and Misuse in Rural Areas, 2025
• Source 2: Merianne Rose Spencer et al., Centers for Disease Control and Prevention, National Centers for Health Statistics, Urban–Rural Differences in Drug Overdose Death Rates, 2020, 2022
• Source 3: Holly Hedegaard and Merianne Rose Spencer, Centers for Disease Control and Prevention, National Centers for Health Statistics, Urban–Rural Differences in Drug Overdose Death Rates, 1999–2019, 2021

ACCESS TO CARE

Rural areas often have fewer clinicians, with over 60% of primary care, mental, and dental health professional shortage areas located in these areas.

• Source 1: Kendal Orgera et al., Association of American Medical Colleges, Rethinking Rural Health, 2023
• Source 2: Rural Health Information Hub, Healthcare Access in Rural Communities, 2025
• Source 3: National Center for Workforce Analysis, Health Resources and Services Administration, State of the Primary Care Workforce, 2024, 2024

Map of Health Professional Shortage Areas: 

• Map of Health Professional Shortage Areas - Primary Care: Rural Health Information Hub, Health Professional Shortage Areas, Primary Care, Geographic, by County, October 2025, 2025
  • NOTE: Based on Health Resources and Services Administration Data Warehouse information, here.
• Map of Health Professional Shortage Areas - Mental Health: Rural Health Information Hub, Health Professional Shortage Areas, Mental Health, Geographic, by County, October 2025, 2025
  • NOTE: Based on Health Resources and Services Administration Data Warehouse information, here.
• Map of Health Professional Shortage Areas - Dental Health: Rural Health Information Hub, Health Professional Shortage Areas, Dental Care, Geographic, by County, October 2025, 2025
  • NOTE: Based on Health Resources and Services Administration Data Warehouse information, here.

Rural individuals also face additional barriers to accessing care, such as: 

• Higher rates of uninsured and underinsured individuals:
  • Source 1: Gina Turrini et al., US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Access to Health Care in Rural America: Current Trends and Key Challenges, 2024
  • Source 2: Munira Z. Gunja, The Commonwealth Fund, Rural Americans Struggle with Medical Bills and Health Care Affordability, 2023
• Greater travel distances to receive care: Madison Hearn et al., Journal of Primary Care & Community Health, Evaluating the Connection Between Rural Travel Time and Health: A Cross-Sectional Analysis of Older Adults Living in the Northeast United States, 2024
• Broadband limitations that impact virtual care capabilities: Rural Health Information Hub, Barriers to Telehealth in Rural Areas

While telehealth may help address provider shortages, rural areas often have reduced access to broadband and devices. 3 million Americans, mostly in rural areas, lack both health care and reliable high-speed internet.

• Source 1: Emily A Vogels, Pew Research Center, Some digital divides persist between rural, urban, and suburban America, 2021
• Source 2: Sarah Jane Tribble and Holly K. Hacker, KFF Health News, Millions in US Live in Places Where Doctors Don’t Practice and Telehealth Doesn’t Reach, 2025

HOSPITAL CLOSURES

Health care access challenges are worsened by ongoing rural hospital closures, further limiting the availability of care: Rural Health Information Hub, Healthcare Access in Rural Communities, 2025

Rural hospitals operate in nearly every state—accounting for at least 1/3 of hospitals in 31 states, 1/2 in 17 states, and over 70% in 7 states: Scott Hulver et al., KFF, 10 Things to Know About Rural Hospitals, 2025

Since 2005, nearly 200 rural hospitals have closed or discontinued inpatient services, and over 400 face serious financial risk.

• Source 1: University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Rural Hospital Closures, 2025
• Source 2: Chartis, 2025 Rural Health State of the State, 2025

Since 2023, more than 40 hospitals have become rural emergency hospitals: University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Rural Emergency Hospitals, 2025

Rural hospital closures and conversions since 2005:

• Source 1: University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Rural Hospital Closures, 2025
• Source 2: University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Rural Emergency Hospitals, 2025

Rural hospitals may face added financial challenges from lower patient volumes, smaller operating margins, and limited patient service offerings:

• Lower Patient Volumes: Scott Hulver et al., KFF, 10 Things to Know About Rural Hospitals, 2025
• Smaller Operating Margins: National Rural Health Association, Overcoming barriers to sustainable growth in rural hospitals, 2025
• Limited Patient Service Offerings: National Rural Health Association, Overcoming barriers to sustainable growth in rural hospitals, 2025

44% of rural hospitals reported negative operating margins in 2023, compared to 35% of urban hospitals: Scott Hulver et al., KFF, 10 Things to Know About Rural Hospitals, 2025

Access to services like obstetrics and chemotherapy has declined in rural communities, even at facilities that continue to provide inpatient care: Chartis, 2025 Rural Health State of the State, 2025

• NOTE: Obstetrics closures are based on 2011 to 2023 data, and chemotherapy closures are based on 2014 to 2023 data. 

STRATEGIES TO SUPPORT RURAL HEALTH

Improve Access to Health Care

• Sustain rural health infrastructure
  • Source 1: Wellmark, The Wellmark Foundation supports the University of Iowa’s SIM-IA to provide lifesaving clinical training and strengthen rural health care, 2025
  • Source 2: Blue Cross Blue Shield of South Carolina, Giving Rural Communities a Blueprint for Health, 2021
  • Source 3: Florida State University, Florida Blue Centers for Rural Health Research and Policy
• Ensure access to essential services like maternal health and substance use disorders
  • Source 1: Robin Buskey, National Academy for State Health Policy, NASHP to Support Eight States in Maternity Care Deserts Policy Academy, 2025
  • Source 2: Spaine Stephens, East Carolina University, Grant expands dental school’s program for oral health care to pre-K, Head Start, 2025
  • Source 3: Arkansas Blue Cross and Blue Shield, Blue & You Foundation awards nearly $1 million to improving Arkansas maternal and pediatric health programs, 2024
• Expand transportation programs that increase access to care: Rural Health Information Hub, Transportation to Support Rural Healthcare, 2025
• Address health disparities and social determinants of health: Rural Health Information Hub, Social Determinants of Health for Rural People, 2025

Explore Care Delivery and Payment Models

• Invest in value-based payment models for rural populations: Rural Health Information Hub, Rural Healthcare Payment and Reimbursement, 2025
• Invest in scalable mobile, school-based, and integrated care models
  • Source 1: Rural Health Information Hub, Mobile Units Model, 2025
  • Source 2: US Centers for Medicare & Medicaid Services, CHART Model, 2025
  • Source 3: Corey Scurlock, National Rural Health Association, Integrating telehealth: Strengthening rural health care delivery, 2023
  • Source 4: Blue Cross and Blue Shield of New Mexico, Care Van Collaborations Bridge Health Care Gaps Across New Mexico, 2025
  • Source 5: Blue Cross and Blue Shield of Montana, Celebrating 10 Years of the Care Van Program, 2025
  • Source 6: Blue Cross and Blue Shield of Texas, OB 'Care on Wheels' Launched to Provide Vital Support for Pregnant Women and Babies in Houston, 2025
• Expand home- and school-based care programs
  • Source 1: Rural Health Information Hub, Rural Schools and Health, 2025
  • Source 2: AZ Blue, Up to 18,000 AZ Blue Medicaid Members May Now Receive Care at Home, 2025
  • Source 3: Arkansas Blue Medicare, DispatchHealth, 2025
  • Source 4: Independence Blue Cross, Independence Blue Cross Post-Acute Care Program improves recovery outcomes, lowers costs, and earns national BCBSA award, 2025
• Invest in telehealth services and broadband access
  • Source 1: American Hospital Association, Mobilizing Technology and Innovation to Support Rural Health, 2025
  • Source 2: Health Resources and Services Administration, Addressing broadband to improve access to telehealth, 2024
  • Source 3: Blue Cross and Blue Shield of Texas, Transforming Maternal and Infant Health Through Tech-Driven Care, 2025
  • Source 4: Gabby Abel, Blue Cross Blue Shield of Michigan partners with Homeward to expand access to care for Medicare Advantage members in Michigan’s Upper and Northern Lower Peninsulas, 2025
  • Source 5: Jasmine Pennic, Blue Cross Blue Shield of Massachusetts Expands Women’s Health Access in MA, 2025

Build and Support the Rural Health Care Workforce

• Improve recruitment, training, and retention: National Institute for Health Care Management, Addressing Health Care Workforce Shortages, 2025
• Expand rural residency and training programs
  • Source 1: Health Resources and Services Administration, Rural Residency Planning and Development (RRPD) Program, 2025
  • Source 2: Emily M Hawes et al., Journal of Graduate Medical Education, Rural Residency Training as a Strategy to Address Rural Health Disparities: Barriers to Expansion and Possible Solutions, 2021
  • Source 3: Elevance Health, Elevance Health-Sponsored Scholarships Encourage Health Professionals to Practice in Rural and Under-Resourced Areas: A Whole Health Story, 2025
• Support workforce and community-based initiatives
  • Source 1: Rural Health Information Hub, Premera Rural Nursing Health Initiative at the University of Washington, 2024
  • Source 2: Elevance Health, Building a Healthcare Provider Pipeline in Underserved Communities, 2022
• Strengthen rural-urban health care system collaboration
  • Source 1: Tulane University, How to Improve Health Care in Rural Areas, 2023
  • Source 2: Arkansas Blue Cross and Blue Shield, Arkansas Blue Cross Awards Arkansas Rural Health Partnership $250,000, 2021

Rural Health Transformation Program

• Source 1: Centers for Medicare & Medicaid Services, Rural Health Transformation Program, 2025
• Source 2: Gabiel Loud & Maya Sandalow, Bipartisan Policy Center, Rural Health Transformation Program: Notice of Funding Opportunity, 2025
• Source 3: National Rural Health Association, Rural Health Transformation Program Summary, 2025
• Source 4: Paragon Health Institute, Rural Health Transformation Fund Offers States a Way to Improve Rural Health Care Access, 2025