Basics

A unique set of geographic, economic, and demographic factors shapes access to healthcare in rural America. Rural communities span vast distances, often lack robust infrastructure, and experience significant challenges in attracting and retaining healthcare providers of all kinds including professional, paraprofessional, paid and unpaid caregivers etc. These barriers contribute to persistent disparities in access to care, health outcomes, and life expectancy compared to urban populations. The U.S. Census Bureau and the Office of Management and Budget officially define rural areas based on population density and distance from metropolitan centers. Nearly 60 million Americans live in rural areas, yet many face disproportionately high rates of poverty, disability, and chronic illness.

Rural Americans are more likely to be older and underinsured, with a higher likelihood of relying on public insurance such as Medicaid or Medicare. A 2023 report from Georgetown University found Medicaid plays an outsized role in small towns and rural areas, providing coverage for millions of individuals with low incomes and helping to sustain local health systems. However, inconsistent insurance coverage, especially in non-expansion states, continues to create coverage gaps affecting individual patient health and hospital finances. Geographic isolation further compounds these disparities. People often delay or forgo care altogether when they do not have access to reliable transportation, particularly specialist visits or non-urgent but necessary preventative or follow-up care. The closure of more than 130 rural hospitals since 2010, with more at risk, has left significant swaths of rural America without emergency or inpatient care, sometimes requiring travel of over an hour to the nearest hospital. Rural health does have some positives to build on including higher rates of trust, familiarity, and community-based approaches.