Reviving Rural Health: A Comprehensive Four-Part Series on Healing America’s Heartland

This essay kicks off a series called Rural Health Resilience, focusing on rural health in America through various perspectives. My experience ranges from treating patients referred from rural hospitals to shaping health companies that make a difference in these communities. I’ve seen firsthand how vital rural health is to the overall well-being of the nation.

Right now, rural America faces a serious health crisis that affects about 60 million people. Defined broadly, rural areas are non-metropolitan regions with lower population density. They stretch from Appalachia to parts of coastal states like California and Florida. These areas are crucial to our nation’s economy and identity, yet they are often left behind when it comes to healthcare access and quality.

Many rural residents suffer from high rates of chronic diseases, mental health issues, and even maternal mortality. Dr. Shannon Monnat, a rural demographer, emphasizes that health outcomes in rural areas are worsening. “The rural U.S. is sick, poor, and losing population,” she says. This isn’t just an abstract problem—these statistics reflect real lives impacted by insufficient healthcare.

Take a look at the numbers:

• Rural Americans face a 20-30% higher chance of dying from heart disease and related diseases.
• They are 50% more likely to experience premature death compared to urban residents.
• Maternal mortality is alarming—60% higher in rural areas, especially among Black and Native women.
• Over 65% of rural counties lack a psychiatrist.
• Since 2010, more than 130 rural hospitals have closed, with over 600 more at risk.

These statistics tell a grim story. The issues extend beyond just healthcare access. Social determinants like housing, income, and education deeply affect health outcomes. As Dr. Carrie Henning-Smith points out, “The biggest drivers of rural health inequities are not medical; they are structural.” Many rural residents lack basic services like reliable transportation and nutritious food, worsening their health conditions.

With an aging population in rural areas, the stakes are even higher. Nearly 20% of rural Americans are over 65, often managing multiple health issues without the care they need. Younger generations move to cities, leaving fewer providers to care for the elderly. Dr. Tim Slack notes that our support systems for health are eroding, especially post-COVID, where telehealth is an option, but often out of reach for many due to poor internet access.

I’ve witnessed the struggles of patients at my healthcare companies. At Monogram Health, we support those unable to reach dialysis centers safely. At Aspire Health, we focus on palliative care for seniors who are homebound and isolated. These are not just ideas; they are proven solutions highlighting that rural care can be successful when designed specifically for local needs.

Rural America is diverse, and its needs vary greatly from one community to another. However, common vulnerabilities exist. As Dr. Monnat suggests, rural areas have strong community networks and resources that can be harnessed for better health outcomes. They require support systems that truly engage with their unique circumstances.

Ignoring the rural health crisis means risking entire communities. The economic implications are significant, and the societal impact cannot be overlooked. Addressing rural health issues is an opportunity to improve healthcare for everyone. As technology evolves, intelligent solutions can make a difference. Next, we’ll dive into the barriers facing rural populations and explore how innovative approaches are bridging these gaps.

If we cannot provide healthcare for the 60 million Americans who play a vital role in our nation, then who are we truly serving?

Footnotes

1. Dr. Shannon Monnat, Lerner Chair for Public Health Promotion, Syracuse University, “Population Health in Rural America,” Aspen Health Strategy Group (AHSG) White Papers, 2025.
2. Dr. Carrie Henning-Smith, Deputy Director, University of Minnesota Rural Health Research Center, “Rural Health in the United States,” AHSG White Papers, 2025.
3. Dr. Tim Slack, Professor of Sociology, Louisiana State University, “Population Health in Rural America,” AHSG White Papers, 2025.

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rural health,critical access hospital,health equity,disparties