Closing the Distance: Fixing Access to Care in Rural America
Part 2 of 4 in the “Rural Health Resilience” Series
In the first essay of this series, we explored the scale of the rural health crisis—nearly 60 million Americans facing higher rates of chronic illness, maternal mortality, and premature death. Step two is understanding what access to care really means—and why it remains so elusive for rural communities.
And it’s not just about miles.
Yes, geography matters. But barriers to access are multi-factorial, and include:
Geographic distance from providers and health facilities
Transportation limitations (especially for older adults)
Shortages of healthcare workers, particularly specialists
Cost (even for those who have some insurance)
Gaps in broadband and digital infrastructure
We can’t solve rural health challenges with urban healthcare models. We need new care delivery mechanisms, new payment models, and new talent pipelines.
That starts with the workforce. More than 60% of designated Health Professional Shortage Areas are rural. Many counties have no OB-GYN, no psychiatrist, sometimes no doctor at all. Research shows that the strongest predictor of whether a healthcare professional will practice in a rural area is having grown up there. This insight underscores the need to invest more intentionally in rural high school health career pathways, community college training programs, and medical education initiatives specifically designed to serve rural communities. Successful models include ETSU’s Quillen College of Medicine and Meharry Medical College, which have a longstanding history of training doctors from underserved regions and sending them back to serve their communities. The same must happen for nurses, pharmacists, and community health workers.
Technology, too, can be transformative—if we invest in it properly. Telehealth has shown great promise, especially for behavioral health, routine consults, and rural provider support. But without reliable broadband, modern healthcare remains out of reach. Millions of rural Americans still lack access to high-speed internet. This must change.
Establishing trust is also vital in building successful rural care models. That means meeting people where they are, using local messengers, and designing care that aligns with values of self-reliance and dignity. Programs like Main Street Health, where local “health navigators” guide patients through the system, show us how effective community-rooted models can be.
At the end of the day, access isn’t an unsolvable puzzle. It’s a design problem. We know what works. It’s time to scale it. Let’s keep building a system that works for all Americans—no matter their ZIP code.
Read more on the rural health crisis in my recent Forbes pieces here and here.
Coming Next in the Series: Part 3: “What Counts” – How Technology Can Transform Rural Health