Skip to main content
Rural Health Information Hub
Rural Health Information Hub

Healthcare Access in Rural Communities

Access to healthcare services is critical to good health, yet rural residents face a variety of access barriers. A 1993 National Academies report, Access to Health Care in America, defined access as "the timely use of personal health services to achieve the best possible health outcomes." A 2014 RUPRI Health Panel report on rural healthcare access summarizes additional definitions of access with examples of measures that can be used to determine access. According to the 2026 article Health Care Access from the Rural Perspective: A Narrative Review, rural areas are disproportionately impacted by geographic and virtual access barriers, healthcare workforce shortages, and the challenges related to upstream drivers of health.

Ideally, residents should be able to conveniently and confidently access services such as primary care, dental care, behavioral healthcare, emergency care, and public health services. Access to healthcare is important for:

  • Overall physical, social, and mental health status
  • Disease prevention
  • Detection, diagnosis, and treatment of illness
  • Avoiding preventable deaths
  • Quality of life
  • Life expectancy

Rural residents often encounter barriers to healthcare that limit their ability to obtain the care they need. Access to healthcare implies that healthcare services are available, affordable, and obtainable in a timely manner. Even when an adequate supply of healthcare services exists in the community, there are other factors that may impede healthcare access. For instance, to have healthcare access, rural residents must also have:

  • Financial means to pay for services, such as health or dental insurance that is accepted by the provider
  • Means to reach and use services, such as transportation to services that may be located at a distance, and the ability to take paid time off of work to utilize services
  • Confidence in their ability to communicate with healthcare providers, particularly if the patient has limited health literacy, language barriers, or a disability impacting their ability to communicate
  • Trust that they can use services without compromising privacy
  • Confidence that they will receive quality care

This guide provides an overview of healthcare access in rural America, including the importance and benefits of healthcare access as well as the barriers that rural residents experience. The guide includes information regarding:

  • The impact of limited healthcare access and facility closures on rural communities
  • Barriers to care, including workforce shortages, health insurance status, transportation barriers, digital and health literacy, and stigma in rural communities
  • Access issues for specific populations and healthcare services
  • Strategies and resources to improve access

Frequently Asked Questions

How does the lack of healthcare access affect population health and patient well-being in a community?

Access to healthcare professionals and facilities is important to rural population health. In 2014, the RUPRI Health Panel publication, Access to Rural Health Care - A Literature Review and New Synthesis, reported that barriers to healthcare result in unmet healthcare needs, a lack of preventive and screening services, challenges in the treatment of chronic diseases, and even a reduced lifespan. While access to medical care does not guarantee good health, access to healthcare is critical for a population's well-being and optimal health. The 2026 article Health Care Access from the Rural Perspective: A Narrative Review identifies potential interventions to overcome geographic, temporal, financial, cultural, and virtual access barriers for rural populations. In the video below, Alan Morgan, CEO of the National Rural Health Association, provides an overview of healthcare access, barriers to care, impacts on the community, and possible solutions:

According to the 2025 article Greater Physician Supply Associated with Lower Mortality in Rural Counties: A 23-Year County-Level Longitudinal Observational Study, "greater physician supply was associated with significantly lower mortality in rural counties," though rural areas consistently have a lower supply of physicians and higher mortality when compared to urban areas. Even when there is access to care, rural residents may have concerns about the quality of the care available. According to the 2025 article Adult Ratings of Neighborhood Medical Care Availability in Nonmetropolitan and Metropolitan Areas, United States 2021, 17.7% of nonmetro adults perceive the medical care in their area to be poor to fair, while only 8.2% of adults in metro areas perceive the same issues of quality.

Travel to reach a primary care provider may be costly and burdensome for patients living in remote rural areas, with subspecialty care often even farther away. These patients may substitute local primary care providers for subspecialists, or they may decide to postpone or forego care. If patients do not have access to primary care or subspecialty care, they may use emergency department (ED) services for their healthcare needs. According to the 2024 article Non-Urgent Use of Emergency Departments by Rural and Urban Adults, 16% of rural adults compared to 13% of urban adults reported ED visits, and 5% of rural adults used the ED for a non-urgent reason compared to 4% of urban adults.

The challenges that rural residents face in accessing healthcare services contribute to geographic health disparities. To learn more about disparities in health outcomes, see the Rural Health Disparities topic guide.

What are barriers to healthcare access in rural areas?

Distance and Transportation

Rural populations are more likely to have to travel long distances to access healthcare services, particularly subspecialist services. This can be a significant burden in terms of travel time, cost, and time away from the workplace. In addition, the lack of reliable transportation is a barrier to care. In urban areas, public transit is generally an option for patients to get to medical appointments; however, these transportation services are often lacking in rural areas. Rural communities often have more older adults who have chronic conditions requiring multiple visits to outpatient healthcare facilities. This becomes challenging without available public or private transportation. For more information on transportation and rural healthcare, see the Transportation to Support Rural Healthcare topic guide.

Workforce Shortages

Healthcare workforce shortages impact healthcare access in rural communities. One measure of healthcare access is having a regular source of care, which is dependent on having an adequate healthcare workforce. Other indicators, such as measures of nonuse (that count rural residents who could not find an appropriate care provider), can further provide estimates of whether a sufficient healthcare workforce is available to rural residents. See What state-level policies and programs can help address the problem of shortages in the rural healthcare workforce? on the Rural Healthcare Workforce topic guide for more information.

A shortage of healthcare professionals in rural areas of the U.S. can restrict access to healthcare by limiting the supply of available services. As of September 2026, 62.06% of Primary Care Health Professional Shortage Areas (HPSAs) were located in rural areas. For the most current numbers, see the Health Resources and Services Administration's (HRSA) Designated Health Professional Shortage Areas Statistics. HRSA also includes statistics on mental health and dental HPSAs.

Primary Care HPSAs are scored 0-25, with higher scores indicating a greater need for primary care providers. This July 2026 map below highlights nonmetropolitan areas with primary care workforce shortages, with areas in darker green indicating higher nonmetro HPSA scores:

U.S. Map of Health Professional Shortage Areas: Primary Care

For more information on workforce challenges, resources, and strategies used to address rural healthcare workforce shortages, see the Rural Healthcare Workforce topic guide.

Health Insurance Coverage and Cost

Individuals without health insurance have less access to healthcare services. According to Geographic Variation in Health Insurance Coverage: United States, 2022, nonmetropolitan children and adults under 65 were generally more likely than their metropolitan peers to be uninsured.

Percent of Population Uninsured by Urbanization Level, 2022
Urbanization Level Adults, ages 18-64 Children, ages 0-17
Large central metropolitan 13.9 3.9
Large fringe metropolitan 10.1 4.0
Medium/small metropolitan 12.2 4.0
Nonmetropolitan 13.9 5.5
Source: Geographic Variation in Health Insurance Coverage: United States, 2022

The cost of healthcare can be an access barrier. The 2023 policy brief, Rural Working-Age Adults Report More Cost Barriers to Health Care, states that rural working adults are more likely than their urban counterparts to report issues with paying medical bills or delaying care because of the cost. However, the cost of healthcare is an issue for both rural and urban residents.

Health insurance affordability is a concern for rural areas. A RUPRI Center for Rural Health Policy Analysis policy brief, Nonmetropolitan Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces in 2022, evaluated unsubsidized and net-of-subsidy marketplace plan premiums in 2022. Average premiums were higher in rural counties than in urban counties. In addition, rural counties were more likely to have fewer than 3 firms participating in the Health Insurance Marketplace. Medicare Advantage plan co-pays and deductibles are higher in rural areas, and no-cost benefits like health clubs and transportation are less frequently offered in rural areas. According to Changes in Marketplace Premiums and Insurer Participation, 2022-2023, rural areas tend to have fewer insurers and little competition among them, which can result in higher premiums.

Broadband Access

While the use of telehealth services was already becoming more popular and widespread at the beginning of 2020, measures implemented in response to the COVID-19 pandemic accelerated this growth. Unfortunately, many areas lack access to broadband Internet and experience slow Internet speeds, both of which are barriers to accessing telehealth services. According to Computer and Internet Use in the United States: 2021, 9.0% of urban households did not have a broadband subscription, compared to 13.4% of rural households. To learn about additional challenges for rural telehealth use, see We have limited broadband in our area. What are our options? and What are the challenges related to providing telehealth services in rural communities? on the Telehealth and Health Information Technology in Rural Healthcare topic guide.

Health Literacy

Health literacy can be a barrier to accessing healthcare. It reflects both an individual's ability to understand health information and the extent to which health systems communicate information clearly. In rural communities, structural factors including limited access to educational resources, healthcare services, and broadband may make it more difficult for residents to obtain and act on health information. Low health literacy can make residents reluctant to seek healthcare due to fear or frustration related to communicating with a healthcare professional. Additionally, navigating the healthcare system can be difficult without health literacy skills. To learn more about low health literacy in rural America, see the Rural Health Literacy Toolkit in our evidence-based toolkits. The Rural Monitor's 2017 two-part series on rural health literacy, Understanding Skills and Demands is Key to Improvement and Who's Delivering Health Information?, explores connections between health and health literacy and how health information is being delivered to rural populations. The Rural Monitor's 2022 two-part series, A New Era of Health Literacy? Expanded Definitions, Digital Influences, and Rural Perspectives and Educating Future Healthcare Providers: Health Literacy Opportunities for Webside Manners, explores health literacy in the digital era.

Social Stigma and Privacy Issues

In rural areas, because there is little anonymity, social stigma and privacy concerns are more likely to act as barriers to healthcare access. Rural residents can have concerns about seeking care for mental health, substance use, sexual health, pregnancy, or even common chronic illnesses due to unease or privacy concerns. Patient discomfort may be due to personal relationships with their healthcare provider or others working in the healthcare facility. Additionally, patients can feel fear or concerns about other residents, who are often friends, family members, or co-workers, who may notice them utilizing services for health conditions that are typically not openly discussed, such as counseling or HIV testing services. The 2024 article Identifying Challenges and Solutions for Improving Access to Mental Health Services for Rural Youth: Insights from Adult Community Members discusses stigma and barriers to mental healthcare in rural areas. Co-location or the integration of behavioral health services with primary care services in the same building can help ease patient concerns. Community programming that promotes positive mental health can destigmatize mental healthcare, and access to telemental health services may help alleviate privacy issues.

Why is primary care access important for rural residents?

Primary care, in addition to emergency care and public health services, is an essential rural healthcare service. Primary care providers offer a broad range of services and treat a wide spectrum of medical issues. The American Academy of Family Physicians characterizes primary care as follows:

“Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings…A primary care practice serves as the patient's entry point into the health care system and as the continuing focal point for all needed health care services.”

A 2005 Milbank Quarterly article, Contribution of Primary Care to Health Systems and Health, identifies the key roles primary care access plays in preventing disease and improving health. Primary care serves as a first entry point into the health system, which can be particularly important for rural residents, who might otherwise face barriers to accessing healthcare. Some benefits of primary care access are:

  • Preventive services, including early disease detection
  • Care coordination
  • Lower all-cause, cancer, and heart disease mortality rates
  • Reduction in low birthweight
  • Improved health behaviors
  • Improved overall health
  • Lower healthcare costs

Rural Healthy People 2030 discusses how residents with limited primary care access may not receive preventive screenings that can lead to early detection and treatment of disease, as well as missing opportunities for behavioral healthcare screening and initiation. Older rural residents may expect longer travel times for primary care compared to their suburban and urban counterparts, allowing for up to 61 minutes of travel time to obtain primary care on average, compared to 53 minutes for suburban and 48 minutes for urban residents, according to Current and Maximum Acceptable Travel Times to Primary Care Among US Older Adults. Despite this willingness to travel, barriers to primary care still persist in rural areas. Primary Care in the United States: A Chartbook of Facts and Statistics reports that preventive care visit utilization, which measures the number of residents who have preventive care visits in a given year, is 35% in rural areas, compared to 45% in urban areas.

What types of healthcare services are frequently difficult to access in rural areas?

Healthcare access is an issue in rural communities across the United States. This section will look at some select healthcare services that may be difficult to access in rural areas.

Home Health

Home health services in rural America are a growing need but can be difficult to access for some rural residents. According to the 2025 article Exploring Access to Critical Health Services for Older Adults in Rural America from 1990 to 2020, access to home health agencies was highest in urban and higher-population rural areas but declined in the most remote communities. Home is Where the Heart Is: Insights on the Coordination and Delivery of Home Health Services in Rural America, a 2017 Rural Health Reform Policy Research Center policy brief, covers many barriers and challenges facing rural home health agencies that affect their ability to provide access in rural areas, including:

  • Reimbursement and insurance coverage
  • Face-to-face requirement
  • Homebound status requirement
  • Changing rules and regulations
  • Workforce
  • Time and resources required to serve patients located at a distance
  • Discharge process and referral difficulties

Despite these barriers, the number of organizations providing home health services in rural areas has grown, according to the 2025 USDA chart Home Healthcare Establishments Serving Rural Areas Increased about 36 Percent from 2010 to 2023. See To what extent are home health services available in rural communities? on the Rural Home Health Services topic guide for more information.

Hospice and Palliative Care

Hospice and palliative care agencies often face barriers and challenges similar to other healthcare services in rural areas. These challenges can include workforce shortages, recruitment and retention difficulties, reimbursement issues, limited access to broadband, and others.

The Rural Hospice and Palliative Care topic guide answers frequently asked questions and provides resources on hospice and palliative care in rural areas. Community-Based Palliative Care: Scaling Access for Rural Populations, a 2018 Rural Monitor article, describes the role palliative care plays in meeting the needs of patients who are chronically and seriously ill and covers challenges to accessing palliative care in rural areas.

Mental Health Services

Access to mental health providers and services is a challenge in rural areas. As a result, primary care providers often fill the gap and provide mental health services. However, primary care providers may face challenges that limit their ability to provide mental healthcare access, such as inadequate financial reimbursement or lack of time with patients.

Rural communities face shortages in mental healthcare providers. As of September 2026, 60.49% of Mental Health Professional Shortage Areas were located in rural areas. For the most current figures, see HRSA's Designated Health Professional Shortage Areas Statistics.

Mental Health HPSAs are scored 0-25, with higher scores indicating a greater need for mental health providers. This July 2026 map below highlights nonmetropolitan areas with mental health workforce shortages, with areas in darker green indicating higher nonmetro HPSA scores:

U.S. Map of Health Professional Shortage Areas: Mental Health

The 2023 report, Rural Health Research Recap: Rural Behavioral Health Workforce, summarizes research from Rural Health Research Centers that shows how rural counties have fewer social workers, psychologists, psychiatric nurse practitioners, and counselors when compared to urban counties. According to the 2025 University of South Carolina Rural Health Research Center policy brief Access and Quality of Mental Health Services in Rural and Urban America, 18% of large rural and over 40% of small/isolated rural ZIP Code Tabulation Areas (ZCTAs) were located 30 minutes or more away from the nearest mental healthcare facility, compared to less than 10% of urban ZCTAs having a drive time of 30 minutes or more to the nearest facility.

Due to the lack of mental health providers in rural communities, the use of telehealth to deliver mental health services is increasing. By using telehealth delivery systems, mental health services can be provided in a variety of rural settings, including rural clinics, schools, residential programs, long-term care facilities, and individual patient homes. Additionally, the Calendar Year (CY) 2022 Medicare Physician Fee Schedule Final Rule made permanent the ability for Federally Qualified Health Centers and Rural Health Clinics to be reimbursed by Medicare for telemental health appointments. However, according to the same University of South Carolina Rural Health Research Center policy brief, ZCTAs that have increased drive time to the nearest mental healthcare facility are also more likely to not have adequate telecommunication devices to utilize telemental healthcare.

The Telehealth and Health Information Technology in Rural Healthcare topic guide has more resources on how telehealth can improve access to care. For additional resources on access to mental health services in rural areas, see the Rural Mental Health topic guide.

Substance Use Disorder Services

Despite a growing need, there is a shortage of substance use disorder services offered in many rural communities across America and there are barriers to accessing those services. According to the 2026 policy brief Comparing the Care and Distance Traveled by Rural and Urban Medicaid Beneficiaries With Opioid Use Disorder, rural Medicaid beneficiaries with opioid use disorder (OUD) complete fewer healthcare visits per year than urban Medicaid beneficiaries with OUD and have to travel twice as far to access care, decreasing the likelihood that this population will receive adequate services. Access to appropriate substance use disorder services is necessary to help individuals initiate treatment and lead healthy lives.

Medically managed withdrawal is an initial step of substance use disorder treatment that involves managing acute intoxication and withdrawal as well as minimizing medical complications. The lack of withdrawal management providers in many rural areas creates a barrier to care that could result in patients forgoing or delaying needed treatment. In lieu of a withdrawal management provider in a rural community, the local emergency room or county jail, although not the most appropriate location for withdrawal management services, must often serve as a substitute. The 2024 article Rural-Urban Differences in Out-of-Network Treatment Initiation and Engagement Rates for Substance Use Disorders reports similar issues, showing that there are lower rates of substance use treatment initiation and engagement in rural areas compared to urban areas.

Access to medication for opioid use disorder (MOUD) as well as medications for treating alcohol use disorder (MAUD) is also limited in rural communities. What's MAT Got to Do with It? Medication-Assisted Treatment for Opioid Use Disorder in Rural America provides an overview of using MOUD as part of evidence-based treatment for opioid use disorder, with information on the science behind the disorder and how 3 medications for opioid use disorder (buprenorphine, methadone, and naltrexone) work. According to Practical Tools for Prescribing and Promoting Buprenorphine in Primary Care Settings, expanding access to buprenorphine for MOUD in rural communities can improve treatment availability. However, workforce shortages, transportation barriers, and limited technology infrastructure can hinder implementation and reduce access to substance use disorder treatment and care. This publication provides recommendations to improve access, such as leveraging non-physician staff to support treatment plans and engaging the local community to build service locations as strategies to overcome barriers.

A shortage of mental health and substance use disorder clinicians in rural communities led to the development of new models to bridge the gap and provide needed services using allied behavioral health workers. Examples include the Nurse Navigator and Recovery Specialist Outreach Program and the ASPIN Network's Community Health Worker Program.

The Substance Use and Misuse in Rural Areas topic guide provides information and resources, answers frequently asked questions, and lists model programs to address substance use disorder and model programs to address opioid use in rural areas.

Reproductive, Obstetric, and Maternal Health Services

Reproductive, obstetric, and maternal healthcare is typically more difficult to access in rural areas. According to KFF's issue brief, Women's Sexual and Reproductive Health Services: Key Findings from the 2020 KFF Women's Health Survey, rural women are less likely to have had a recent Pap test and less likely to have access to a provider who discussed reproductive health issues with them, such as contraception, sexual and relationship history, sexually transmitted infections (STIs) and other transmissible diseases, pre-exposure prophylaxis (PrEP), and menopause.

Access to obstetric services is a persistent concern in rural areas. A 2022 Center for Economic Analysis of Rural Health policy brief, County-Level Availability of Obstetric Care and Economic Implications of Hospital Closures on Obstetric Care, reports that out of 148 counties that lost obstetric services between 2012 and 2019 due to hospital or unit closures/conversions, 113 of the counties were rural. Additionally, a 2020 action plan from the U.S. Department of Health and Human Services, Healthy Women, Healthy Pregnancies, Healthy Futures: Action Plan to Improve Maternal Health in America, points out that although 15% of people in the U.S. live in rural communities, only 6% of OB/GYNs serve these areas. However, many rural family physicians provide broad OB/GYN services to their patients. To assist in understanding maternal healthcare shortages, the federal government has created a designation of Maternity Care Target Area (MCTA), which denotes areas within existing Primary Care Health Professional Shortage Areas (HPSAs) experiencing a shortage of maternity healthcare professionals.

A 2020 case study Making It Work: Models of Success in Rural Maternity Care discusses 3 rural obstetric service providers and highlights the importance of strong partnerships, collaboration, and community support to maintain successful rural maternity care. The Rural Maternal Health Toolkit provides program models and implementation strategies to support maternity care in rural areas.

The report Restoring Access to Maternity Care in Rural America discusses strategies to improve maternal care, such as creating maternity care networks, promoting visibility for care, helping rural providers care for patients with high-risk pregnancies, utilizing telemedicine, expanding and training the rural healthcare workforce, enlisting nonclinical partners, and more.

For more information on rural maternal health issues and strategies to address them, see the Rural Maternal Health topic guide.

Oral Health Services

Oral health can affect overall physical and emotional health. For example, oral health needs that are not addressed can lead to pain, chronic disease, or cosmetic concerns that can impact well-being and professional success. Despite the importance of oral health, dental care can be limited or difficult to access in many rural and remote communities.

Traditionally, health insurance plans have not covered oral health services. A separate dental insurance plan is needed to cover oral health services and procedures. According to the 2021 National Institutes of Health report Oral Health in America, fewer rural residents have dental insurance compared to urban residents. According to the 2026 policy brief Rural-Urban Differences in Dental Care Utilization After a Public Health Emergency, residents with dental insurance were 16% less likely to delay dental appointments.

Another factor limiting access to dental services is the lack of dental health professionals in rural and underserved areas. As of September 2026, 64.06% of Dental Health Professional Shortage Areas were located in rural areas. For the most current numbers, see HRSA's Designated Health Professional Shortage Areas Statistics. According to the 2020-2021 HRSA Area Health Resource Files, there are 7.5 dentists per 10,000 residents in metropolitan areas and 4.7 dentists per 10,000 residents in nonmetropolitan areas. The lack of dental professionals in rural areas can lead to poor oral health in rural residents.

Dental Health HPSAs are scored 0-26, with higher scores indicating a greater need for dental health providers. This July 2026 map below highlights nonmetropolitan areas with dental health workforce shortages, with areas in darker green indicating higher nonmetro HPSA scores:

U.S. Map of Health Professional Shortage Areas: Dental Health

A May 2018 National Rural Health Association policy brief, Improving Rural Oral Healthcare Access, offers recommendations to address dental workforce shortages and to ultimately improve access to oral health services, including:

  • Providing rural training tracks during dental education
  • Admitting dental students from rural areas who would be more likely to practice in a rural community
  • Providing dental students opportunities to obtain a broad range of dental skills which will be needed in a rural practice
  • Helping rural communities recruit and retain oral health providers through local community development programs

For more information, see What oral health disparities are present in rural America? on the Oral Health in Rural Communities topic guide.

Specialty Care Services

Specialty care services are less likely to be available in rural areas, requiring residents to forgo care or travel long distances to access needed services. According to the 2025 article Disparities in Multi-Modal Spatial Access to Primary and Specialty Care in U.S. Neighborhoods: A Cross-Sectional and Temporal Analysis of Health Services, nonmetropolitan areas have less access to various types of specialty care, including pulmonology, nephrology, and cancer care, than metropolitan areas, exacerbating rural health disparities. The policy report Supply, Distribution, and Access to Cardiologists, Neurologists, Oncologists, and Pulmonologists in the Rural and Urban U.S. provides similar findings, stating that the supply of specialty physicians in rural areas was significantly lower than in urban areas per 100,000 people, with 2.6 cardiologists in rural compared to 7.3 in urban, 1.1 neurologists in rural compared to 4.1 in urban, 2.2 oncologists in rural compared to 6.6 in urban, and 0.9 pulmonologists in rural compared to 1.4 in urban, despite heart disease, stroke, cancer, and chronic lower respiratory disease being the leading causes of mortality in rural areas. For more information on various types of specialty care issues in rural areas, see the specialty care topic in the resource library.

How do rural healthcare facility and service closures impact access to care?

Just as barriers to healthcare access can impact the well-being of rural residents, the closure of rural healthcare facilities or the discontinuation of services can also have a negative impact on rural communities. Local rural healthcare systems are often fragile; when one facility closes or a provider leaves, it can impact care, access, and the ability to recruit new healthcare professionals.

There are multiple factors that can affect the severity and impact of a hospital or healthcare facility closure on healthcare access, including:

  • Distance to the next closest provider
  • Availability of alternative services
  • Transportation services
  • Community members' socioeconomic and health status

Traveling to receive healthcare services places the burden on patients. For individuals with low incomes, no paid time off from their jobs, physical limitations, acute conditions, or no personal transportation, these burdens can significantly affect their ability to access healthcare services.

Hospital Closures

Hospital closures create access issues for rural residents. A 2015 findings brief from the North Carolina Rural Health Research Program, A Comparison of Closed Rural Hospitals and Perceived Impact, identifies the following potential impacts on healthcare access due to hospital closure:

  • Unstable health services, particularly diagnostic and lab tests, obstetrics, rehabilitation, and emergency medical care
  • Rising EMS costs
  • Residents not receiving needed care or services due to lack of transportation
  • Greater impact on access for older adults, people with low incomes, people with disabilities, and other groups in need

According to the 2025 report Impact of Hospital Closure on Rural Communities: A Qualitative Study, further impacts include:

  • A decline in access to regular, necessary, and emergent care
  • Negative impacts on rural businesses and the local economy
  • Loss of jobs

The North Carolina Rural Health Research Program maintains an interactive map that displays locations of rural hospital closures in the U.S. from January 2005 to present. As of October 7, 2026, the map shows 109 rural hospitals have completely closed since 2005, and 88 have converted to a different form of healthcare facility. Unfortunately, rural health experts believe rural hospital closures are likely to continue because many rural hospitals have minimal operating margins with little room for financial loss.

In emergency situations, care delays can have serious adverse consequences for patient outcomes. Alternative models and provider types may be needed to meet access needs in rural areas in the event of closures. The 2020 research brief, Alternatives to Hospital Closure: Findings from a National Survey of CAH Executives, explores options to maintain access in rural communities whose hospitals are encountering negative profit margins. Starting in 2023, converting to a Rural Emergency Hospital (REH) is an option for rural hospitals as an effort to maintain some emergency services in rural areas. For more information, see the Rural Emergency Hospitals topic guide.

Nursing Home Closures

Additional closures impacting rural areas can be seen in nursing homes in nonmetropolitan counties. Trends in Nursing Home Closures in Nonmetropolitan and Metropolitan Counties in the United States, 2008-2018 shows that in this time span 472 nursing homes closed in 400 nonmetropolitan counties and as of 2018, 10.1% of rural counties in the U.S. were considered nursing home deserts. According to Nursing Home Closures and Trends: June 2015 - June 2019, the impact of closure is significant for rural communities, which have fewer options for nursing home care and rely on healthcare facilities as centers for employment. Nursing Home Closures and Access to Post-Acute Care and Long-Term Care Services in Rural Areas states that rural areas experiencing closures have longer distances to travel to the next available nursing home offering post-acute care, an average of 6.4 miles compared to 0.94 miles for urban areas. The article shows similar results for long-term care services, with 7.2 miles of travel for rural areas and 1.1 miles for urban areas.

Pharmacy Closures

Maintaining pharmacy services in rural towns can also be a challenge due to financial pressures, low prescription volume, reimbursement challenges, and workforce shortages. When a community's only pharmacy closes, it creates a void and residents must adapt to find new ways to meet their medication needs. The 2026 article “The Crux of the Community”: A Qualitative Focus Group Study of the Impact of Community Pharmacy Closures in Colorado and Utah discusses how closures caused pharmacy deserts, harmed local economies, disrupted patient care, and challenged workforce recruitment beyond just pharmacy professionals. Closures can be difficult for older patients or people with disabilities who rely on pharmacy care to assist in managing their medications.

A 2024 data brief from the RUPRI Center for Rural Health Policy Analysis, Changes in Rural Pharmacy Presence 2023, describes rural communities that lost pharmacy services between 2018 and 2023:

  • 20.5% of the population was aged 65 and older
  • Unemployment was at 3.9%
  • Uninsured rates were 9.2%
  • 17.8% were impoverished
  • 17.6% were living with a disability

The 2024 article, Locations and Characteristics of Pharmacy Deserts in the United States: A Geospatial Study, states that locations considered pharmacy deserts are more likely to have a population with lower educational attainment, have lower rates of insurance coverage, fewer English-speaking residents, and more residents with an ambulatory disability.

A 2022 RUPRI Center for Rural Health Policy Analysis brief states: "Between 2003 and 2021, the number of retail pharmacies declined in noncore rural areas by 9.8 percent, and in rural micropolitan areas by 4.4 percent, while the number in metropolitan areas increased by 15.1 percent during the same period." For more information on rural pharmacy access or challenges rural pharmacies face, see the Rural Pharmacy and Prescription Drugs topic guide.

What are some strategies to improve access to care in rural communities?

Improving access to healthcare in rural communities often requires creativity, collaboration, and flexible strategies to meet the needs of patients. Below are some examples of how healthcare professionals, systems, and communities can remove access barriers for their residents.

Alternative Delivery Models

In 2023, a new Medicare provider type was implemented, the Rural Emergency Hospital (REH), which is designed to maintain access to emergency and outpatient care in rural areas. Some hospitals may choose to convert to an REH rather than initiating a complete closure of the facility. For more information, see the Rural Emergency Hospital topic guide.

Community Paramedicine is a model of care in which paramedics and emergency medical technicians (EMTs) operate in expanded roles to assist with healthcare services for those in need without duplicating available services already existing within the community. The Community Paramedicine topic guide describes how this model of care can benefit rural communities and covers steps to starting a rural community paramedicine program. More information on developing community paramedicine or mobile integrated health programs can also be found in the Rural Mobile Healthcare Toolkit.

The Community Health Worker (CHW) model facilitates healthcare access by using CHWs as a liaison between healthcare providers and rural residents to facilitate access to care and ensure their healthcare needs are met. The Community Health Workers in Rural Settings topic guide offers information and resources on CHWs and covers CHW education, training, and certification.

Care coordination and team-based care models, such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs), can also extend access to primary care services in rural communities. A variety of rural medical home and care coordination programs are highlighted in the Rural Health Models and Innovations section.

Mobile Health is a service delivery model that brings services such as primary care, dental care, and pharmacy care to the location of the patient. The 2025 article Beyond the Clinic Walls: Exploring the Potential of Mobile Health discusses how mobile health can increase access to care for patients in rural areas. Please see the Mobile Healthcare Toolkit for more information on program models.

Affiliation with Larger Systems or Networks

Local rural healthcare facilities may choose to join healthcare networks or affiliate themselves with larger healthcare systems as a strategic move to maintain or improve healthcare access in their communities. These affiliations or joining of healthcare networks may improve the financial viability of the rural facility, provide additional resources and infrastructure for the facility, and allow the rural healthcare facility to offer new or expanded healthcare services they could not otherwise provide. However, the benefits of an affiliation with a larger healthcare system may come at the expense of local control.

The 2018 RUPRI Center for Rural Health Policy Analysis report, The Rural Hospital and Health System Affiliation Landscape – A Brief Review, discusses the various types of hospital affiliations that rural hospitals might consider and factors that might affect which option rural hospitals choose, such as maintaining local decision-making authority and meeting the demands of the hospital system affiliation. The report covers some benefits hospital system affiliation can afford a rural hospital, including access to:

  • Technology
  • Staff recruitment and retention
  • Group purchasing
  • Increased access to healthcare and operational services
  • Ability to adapt to value-based payment models
  • Improved performance

For facilities and providers who wish to remain independent, networks are a way to collaborate to create economies of scale and work toward mutual goals. Networks allow for the sharing of resources, group purchasing, and shared services, among other activities. Clinically integrated networks (CINs) are complex organizations that extend their collaborations into the clinical realm, creating efficiencies and quality care by working together and holding each other accountable to achieve mutual goals. For more information on these strategies, see the Rural Monitor article, Better Together: Rural Hospital High-Value Networks.

Efforts to Improve the Workforce

An adequate workforce is necessary for maintaining healthcare access in a community. In order to increase access to healthcare, rural communities must use their healthcare professionals in the most efficient and strategic ways. This might include allowing each professional to work at the top of their license, integrating new provider types, working in interprofessional teams, and creative scheduling to offer clinic time outside of regular work hours. The 2025 article Investing in Primary Care: The Nurse Practitioner Will See You Now discusses how nurse practitioners (NPs) can be a crucial access point for primary care in rural areas, providing an example of how communities with limited access to physicians can maintain quality healthcare.

The 2024 report Access to Health Care in Rural America: Current Trends and Key Challenges features a variety of federal workforce programs that address healthcare workforce issues in rural communities. The Rural Healthcare Workforce topic guide discusses how rural areas can address workforce shortages, such as partnering with other healthcare facilities, increasing pay for staff, adding flexibility and incentives to improve recruitment and retention of healthcare providers, and using telehealth services. The guide also discusses state and federal policies and programs to improve the supply of rural health professionals, such as loan repayment programs and visa waivers.

Telehealth and Healthcare Technologies

Telehealth is considered to be a key tool to help address rural healthcare access issues. Through telehealth, rural patients can see subspecialists in a timely manner while staying in the comfort of their home or local facility. Local healthcare providers can also benefit from subspecialists' expertise provided via telehealth. However, there is the potential for unequal access to these services due to a lack of broadband Internet access in some rural areas. The 2022 article Geospatial Analysis of Access to Health Care and Internet Services in the US shows that though counties with Internet access were positively correlated with more available healthcare access, rural counties had less Internet availability and were more likely to be situated in a healthcare desert. According to the Federal Communications Commission 2020 Broadband Deployment Report, 22.3% of rural Americans and 27.7% of Americans living in tribal areas lack fixed terrestrial broadband coverage, compared to 1.5% of Americans who lack coverage in urban areas.

An additional concern is the potential that access to telehealth services may supplant, rather than support, primary and subspecialist care in hard-to-reach areas, causing unintended consequences to healthcare facilities in rural areas. Financial Effects of Remote Product Delivery: Evidence from Hospitals draws attention to this concern, discussing issues such as loss of patient volume and financial burdens in rural hospitals due to distant providers acquiring rural patients through telehealth. Improving healthcare access in rural areas requires a balance of telehealth options and sustainable in-person healthcare.

Rural areas may find other healthcare technologies helpful in improving access, such as utilizing artificial intelligence (AI) to improve efficiencies or offering drone delivery of medicines, as discussed in the 2025 article Innovative Rural Hospitals Think Beyond Tradition to Improve Access to Care.

The Telehealth and Health Information Technology in Rural Healthcare topic guide provides a broad overview of how telehealth is being used in rural communities to improve healthcare access. The guide covers specific programs currently in use in rural areas, as well as providing resources and a listing of funding and opportunities that can be used to support telehealth solutions.

What can be done to improve healthcare access for special populations in rural communities?

Rural communities across the United States may struggle to provide adequate healthcare access to their residents, but certain populations within rural areas may encounter additional barriers. For example, rural veterans who rely on Veterans Affairs (VA) services for healthcare may find travel to the nearest facility unmanageable. The 2024 U.S. Senate Committee on Veterans' Affairs hearing, Frontier Health Care: Ensuring Veterans' Access No Matter Where They Live, discusses issues related to rural veteran healthcare access, such as staffing, broadband, distance to healthcare providers, and more. To learn more about VA services for rural veterans or the VA's efforts to address veterans' healthcare access, see the Rural Veterans and Access to Healthcare topic guide.

People with disabilities may also experience challenges when trying to secure appropriate healthcare and services in rural areas. The 2026 article Access to Health Care by Rurality and Disability Status states that compared to adults without disabilities, people with disabilities in both rural and urban areas were more likely to report barriers to accessing healthcare. Additionally, 16% of rural people with disabilities cited transportation as a reason for delaying healthcare, compared to 14% of urban people with disabilities.

Other populations such as farmers, aquacultural communities, migrant and seasonal farmworkers, tribal communities, and pregnant women residing in rural areas may have unique healthcare access needs. Please see the following topic guides for more information:

What organizations work to improve rural healthcare access?

Many organizations work to meet the needs of rural communities and help ensure the availability of essential healthcare services.

How are private foundations working to improve healthcare access?

Many private foundations work to improve healthcare access by funding transportation services, improving workforce, and addressing other factors that affect rural healthcare access. Investing in existing safety net providers and programs, offering grants to develop and implement innovative healthcare delivery models, and funding research to study policy implications as they relate to rural healthcare access are all examples of actions foundations can take to support rural healthcare access.

A 2017 article published in Health Affairs, Foundations' Efforts to Improve Rural Health Care, covers private foundation projects focused on improving access to rural healthcare.

Grantmakers in Health offers multiple resources that provide education and guidance to foundations interested in improving rural healthcare access, such as Improving Health Care Access: Grantmakers Share Their Experiences and Improving Health Access in Communities, Lessons for Effective Grantmaking.

Last Updated: 10/8/2026