About NRHA

About Rural Health Care

The obstacles faced by health care providers and patients in rural areas are vastly different than those in urban areas. Economic factors, cultural and social differences, educational shortcomings, lack of recognition by legislators and the sheer isolation of living in remote areas all conspire to create health care disparities and impede rural Americans in their struggle to lead normal, healthy lives.

Workforce Shortage Problems

  • Ease of access to a physician is greater in urban areas. The patient-to- primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas. This uneven distribution of physicians has an impact on the health of the population.[2]
  • There are 30 generalist dentists per 100,000 residents in urban areas versus 22 per 100,000 in rural areas.[3]  

Socioeconomic Factors

  • Rural residents tend to be poorer. On average, per capita income in rural areas is $9,242[4] lower than the average per capita income in the United States, and rural Americans are more likely to live below the poverty level. The disparity in incomes is even greater for minorities living in rural areas. About 25 percent of rural children live in poverty.[5]
  • People who live in rural America rely more heavily on the Supplemental Nutrition Assistance Program (SNAP) benefits program. According to the Center for Rural Affairs, 14.6 percent of rural households receive SNAP benefits, while 10.9 percent of metropolitan households receive assistance. In all, 1.1 million households receive SNAP benefits.[6]
  • Rural residents have greater transportation difficulties reaching health care providers, often traveling great distances to reach a doctor or hospital.
  • Tobacco use is a significant problem among rural youth. Rural youths over the age of 12 are more likely to smoke cigarettes (26.6 percent versus 19 percent in large metro areas). They are also far more likely to use smokeless tobacco, with usage rates of 6.7 percent in rural areas and 2.1 percent in metropolitan areas.[7]
  • Fifty-three percent of rural Americans lack access to 25 Mbps/3 Mbps of bandwidth, the benchmark for internet speed according to the Federal Communications Commission.[8] Lack of high-speed internet access can be a hindrance to accessing information, representing another challenge rural Americans face.
  • Rural communities have more uninsured residents, as well as higher rates of unemployment, leading to less access to care.

Health Inequity

  • More than 50 percent of vehicle crash-related fatalities happen in rural areas, even though less than one-third of miles traveled in a vehicle occur there.[9]
  • In rural areas there is an additional 22 percent risk of injury-related death.[10]
  • Rural areas have more frequent occurrences of diabetes and coronary heart disease than non-rural areas.[11]
  • Mental health creates new challenges in rural areas, such as:
    • Accessibility: Rural residents often travel long distances to receive services, are less likely to be insured for mental health services, and less likely to recognize the illness.
    • Availability: Chronic shortages of mental health professionals exist, as mental health providers are more likely to live in urban centers.
    • Acceptability: The stigma of needing or receiving mental health care and fewer choices of trained professionals create barriers to care.[12]
  • Rural youth are twice as likely to commit suicide.[13]
National Rural Health Snapshot Rural Urban
Percentage of population 19.3% 80.7%
Number of physicians per 10,000 people 13.1 31.2
Number of specialists per 100,000 people 30 263
Population aged 65 and older 18% 12%
Average per capita income $45,482 $53,657
Non-Hispanic white population 69-82% 45%
Adults who describe health status as fair/poor 19.5% 15.6%
Adolescents who smoke 11% 5%
Male life expectancy in years 76.2 74.1
Female life expectancy 81.3 79.7
Percentage of dual-eligible Medicare beneficiaries 30% 70%
Medicare beneficiaries without drug coverage 43% 27%
Percentage covered by Medicaid 16% 13%
All information in this table is from the Health Resources and Services Administration and Rural Health Information Hub.

The National Rural Health Association strongly recommends that definitions of rural be specific to the purposes of the programs in which they are used and that these are referred to as programmatic designations and not as definitions. Programs targeting rural communities, rural providers and rural residents do so for particular reasons, and those reasons should be the guidance for selecting the criteria for a programmatic designation (from among various criteria and existing definitions, each with its own statistical validity). This will ensure that a designation is appropriate for a specific program while limiting the possibilities that other unrelated programs adopt a definition that is not created to fit that program.
Family physicians comprise only 15 percent of the U.S. outpatient physician workforce nationwide, but they provide 42 percent of the care in rural areas.
[1] American Academy of Family Physicians. (2015). Rural Practice, Keeping Physicians In. Retrieved October 7, 2015, from AAFP.org.)
[2] Hing, E, Hsiao, C. US Department of Health and Human Services. State Variability in Supply of Office-based Primary Care Providers: United States 2012. NCHS Data Brief, No. 151, May 2014.
[3] Doescher, M. P., MD, MSPH, Keppel, G. A., MPH, Skillman, S. M., MS, & Rosenblatt, R. A., MD, MPH, MFR. (2009). The Crisis in Rural Dentistry (Issue brief).
[4] Rural Health Information Hub. (2016). Social Determinants of Health. Retrieved June 8, 2016.
[5] United States Department of Agriculture. (2015, December 17). Poverty Overview. Retrieved June 8, 2016.
[6] Bailey, J. M. (2014, July). Supplemental Nutrition Assistance Program and Rural Households. Retrieved June 8, 2016.
[7] Rural Health Information Hub. (2015, May 15). Substance Abuse in Rural Areas. Retrieved June 8, 2016.
[8] Federal Communications Commission. (2015, February 4). 2015 Broadband Progress Report. Retrieved June 9, 2016.
[9] Urban/Rural Comparison. (2016, February). Retrieved June 13, 2016.
[10] Myers, S. R., C. C. Branas, B. C. French, M. L. Nance, M. J. Kallan, D. J. Wiebe, and B. G. Carr. "Safety in Numbers: Are Major Cities the Safest Places in the United States ?" American College of Emergency Physicians 62, no. 4 (2013): 408-18. 2013. Accessed June 13, 2016. doi:10.1016/j.annemergmed.2013.05.030.
[11] O'Connor, A., & Wellenius, G. (2012, April 24). Rural-urban disparities in the prevalence of diabetes and coronary heart disease. The Royal Society for Public Health, 126(10), 813-820. doi:10.1016/j.puhe.2012.05.029.
[12] Rural Mental Health. (2014, December 15).
[13] Why is the Risk of Youth Suicide Higher in Rural Areas?