When you think of rural America, you might picture mountains, open fields, and close-knit communities. Rural communities are known for strength and self-reliance, but with health care, that resilience is often put to the test. People who live far away from cities face big challenges when it comes to staying healthy, and sadly, those challenges often cost lives.
Studies show rural counties have worse health outcomes than cities. According to the National Library of Medicine, rural areas rank lower on most health measures. People in these areas are more likely to have chronic illnesses like diabetes and heart disease. They also have lower birth rates and shorter life expectancy.
These gaps are not closing. In fact, the problem is getting worse. Between 2015 and 2019, health indicators in rural areas dropped faster than in cities and suburbs. This means more preventable hospital visits, untreated illnesses, and people having to work harder to get care.
There are many reasons why rural areas have such worse health outcomes. Location, limited providers, money, and cultural differences all play a role in this crisis. Many people live hours away from the nearest hospital, and finding a specialist can be nearly impossible. In emergencies, that distance can mean life or death. Rural areas also have a lack of public transportation, making travel to see a healthcare provider even harder. There is also a shortage of health care workers. A 2024 report from WWAMI Rural Health Research Center found rural areas have had severe doctor shortages for decades. Some counties don’t have a single doctor. This means community health workers and informal caregivers are often the ones to bridge these gaps.
Funding cuts make all these problems worse. For example, Augusta Medical Group in southwest Virginia closed three locations after Medicaid and federal funding were reduced. Now, patients who used to drive a few miles to get to the doctor have to make a 30+-minute journey. For people without a car, even a 10-mile difference can feel impossible. In addition, it is unclear how many medical professionals in these locations have been let go and how that will affect patient care. These closures ripple through communities and test the resilience of local organizations and neighbors as they step up to help.
Money is also a big issue. Rural residents often earn less and have higher uninsured rates. Many don’t get health insurance through work and do not qualify for Medicaid. Even when they do, cuts to Medicaid hit rural areas hardest. In Virginia, nearly 19% of adults under 65 in rural areas rely on Medicaid, compared to 14% in cities. In older adults, almost 12% are covered by Medicaid compared to 10% in cities. Health care costs, travel expenses, and chronic illnesses push many families deeper into poverty, creating a cycle of poor health and financial stress.
Culture plays a role as well. Health literacy, understanding health information, is often lower in rural areas. Social isolation and a distrust of health care systems make things worse. In some communities, there is a stigma around being sick and asking for help, especially for mental health. Limited mental health services lead to untreated conditions, more substance abuse, and higher rates of suicide compared to cities.
Luckily, there are solutions. Telehealth has helped by bringing care to people without the long drive. Mobile clinicals also bring doctors to where people are in the community. Additionally, programs that offer student loan forgiveness can attract more health providers to rural areas. For many rural areas, community spaces have started to serve as health hubs by meeting residents where they are and with those they trust. The key to these solutions is trust and local involvement. Rural health works best when it meets people where they are.
Even with these challenges, rural communities show remarkable strength. Unpaid caregivers, neighbors checking in on one another, and community health workers often serve as the first line of support. Faith communities, food pantries, and local social groups work endlessly to bridge the gaps in care. Offering not only essential resources, but also trust and connection with their community. These efforts are a lifeline for many, proving that health care in rural America is not only about clinics and hospitals, but people caring for people. Recognizing and supporting these networks is the key to improving health outcomes.
Health care in rural America is more than a policy issue. It is a matter of life and death. Distance, cost, and limited resources create barriers that leave millions without the care they need. These challenges will not disappear overnight, but telehealth, mobile clinics, provider incentives, and the support from neighbors show that progress is possible. Most importantly, improving rural health means listening to communities and building trust. When care meets people where they are and when communities step up to help one another, everyone has a better chance at living a healthier life.
Ty Mynes is a Communications Specialist and Writer at JABA.