Facing Challenges: Overcoming Obstacles to Healthcare Services in Rural Communities

Rural communities in the United States have long faced unique challenges when it comes to healthcare. These communities suffer from significant issues such as limited and insufficient health services and resources, a shortage of available providers, long distances between rural communities and health care providers, and inadequate infrastructure. Rural residents are more likely to miss routine health maintenance visits that in-turn have negative impacts on their overall health and threaten the well-being of the community.  Without proper medical and dental care rural populations can suffer from poor health outcomes due to delays in diagnosis and treatment compared to their urban counterparts, higher mortality rates, and decreased quality of life.  There are strategies and solutions that can be implemented to address these issues.  By doing so, those living in rural areas can receive the quality care they need to stay healthy. 

In order to close these rural health care disparities, it is important to understand the scope of the problem and identify potential solutions. This article will discuss rural health care disparities in the United States and explore various strategies that rural healthcare organizations are using to improve access to care for rural patients. By understanding and addressing the challenges facing rural healthcare in the US, rural communities and healthcare providers can work together to ensure that everyone has access to healthcare services.

Overview of rural healthcare disparities and in the US and why they exist

Rural healthcare disparities in the US exist for a number of reasons, including economic, geographic, and sociocultural factors.

Rural populations face economic barriers impacted by slower population growth or decline, which can lead to fewer available health care resources.  The poverty rate in rural areas can be higher than in urban areas, making it difficult to afford necessary medical and dental care.  This can lead to challenges accessing health services, lack of insurance coverage, inadequate transportation, and limited resources and services.  Difficulty accessing services due to limited resources can mean that people living in rural areas may have to travel long distances just to get basic dental or medical care. 

Geographic barriers also contribute to the healthcare challenges rural communities face.  Rural communities are typically isolated making it difficult for rural patients to access specialized care or resources that may not be available within their community.  The isolation creates long distances between rural communities and their healthcare providers, on top of limited public and personal transportation options, and lack of rural infrastructure. 

Sociocultural factors, such as stigma and trust, play a role in rural medical and dental health care disparities.  Cultural or language barriers, lack of educational resources, and limited access to technology contribute to disadvantages that rural patients may face.  Trust in rural medical and dental healthcare in the United States is a critical factor to consider when discussing access to care.  The mistrust is often perpetuated by a lack of knowledge and education about available services, which can result in patients being less likely to seek out preventative care or follow up with their doctor. 

Rural health disparities are not just an issue of the present but a generational one.  The generational effects of rural healthcare disparities potentially lead to a cycle of poor health outcomes continuously passed down from parent to child.  The lack of access to health care in these areas can led to high rates of preventable diseases, such as diabetes, hypertension, obesity, and heart disease.  Moreover, mental health issues often go untreated in families due to the stigma associated with seeking help.  The consequences can be seen in high smoking rates, poor nutrition, low activity levels, inadequate housing conditions, and limited access to educational opportunities.  In order to address these issues effectively it is critical to also look at them from a generational perspective and understand how they contribute to long term gaps in care for both adults and children living in rural communities.

All of these economic, geographic, and sociocultural issues combine to create a difficult environment for rural patients who are struggling to receive adequate healthcare services essential for good health outcomes.

Rural healthcare organization and community strategies

Rural healthcare organizations and communities have implemented various strategies to address rural health care disparities and solutions to improve access.  Additionally, providing technological resources, improving infrastructure, and enhancing public health education can help with patient, provider, and community support.

Virtual and digital technology, like telehealth and mobile health (mHealth), have become important tools for providing health care to rural communities in the United States.  mHealth technology refers to the use of mobile devices and applications such as smartphones and tablets to facilitate remote patient care and monitoring.  By utilizing virtual and digital technology, health care providers can provide care to individuals living in rural communities and ensure that those who may otherwise not receive preventative checkups or timely treatment have access to care.  This technology allows for improved communication between doctors or specialists and patients. 

Mobile health clinics are also an option for providing care in remote areas.  Mobile health clinics can be a cost-effective solution that provide an array of services, including primary care exams, chronic disease management and follow up visits, women's health screenings, remote imaging capabilities, laboratory testing, and vaccinations.  They are often staffed by experienced healthcare personnel who understand the unique needs of rural populations.  By partnering with local health care providers, mobile health clinics can ensure that their services are tailored specifically to meet the needs of each community they serve.  Mobile health clinics offer a valuable service to rural communities, providing access to care that otherwise may not be available.

School based health clinics (SBHCs) are an important part of the health care landscape providing convenient access to care in rural communities.  These clinics provide a range of services from primary care and preventative care exams to chronic disease management and follow up visits, including mental health and dental services.  By providing these services in a school setting – a centralized location – these clinics are able to make health care more accessible for students and their families by eliminating transportation barriers and focus on areas where resources are most lacking.

In addition to providing improved access to health care, school-based health clinics can also help reduce disparities in health care by increasing the availability of medical professionals and services in rural communities.  School nurses provide a unique benefit to rural communities in that they understand the specific needs of these populations and are often able to form positive relationships with students and their families.  By partnering with local health care providers, and often staffed by experienced medical personnel who understand the specific needs of rural populations, SBHC's can ensure that their services are tailored specifically to meet the needs of each community they serve.  SBHCs allow more patients to be seen and treated regardless of their socioeconomic status or geographical location and help reduce student absences due to illness.  The presence of these clinics can be a cost-effective and accessible solution for providing care to improve the overall health of rural communities while reducing burdens and strains on the local health care system.

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) also provide care, programs, and resources in rural communities.  RHCs is a certified program intended to increase access to primary care services to patients in rural communities and can be public, nonprofit, or for-profit healthcare facilities.  RHCs are required to use a team approach of physicians working with non-physician providers such as Advanced Practice Providers (e.g. nurse practitioners, physician assistants) and certified nurse midwives to provide services. The clinic must be staffed at least 50% of the time with an APP or CNM.  RHCs are required to provide outpatient primary care services and basic laboratory services.  FQHCs are federally funded nonprofit health centers or clinics that serve medically underserved areas and populations. FQHCs provide primary care services regardless of patient ability to pay. Services are provided on a sliding scale fee based on patient ability to pay.      

Examples of rural healthcare initiatives, models, and programs

The Rural Health Information Hub is an outstanding source for all kinds of rural health resources.  The Rural Health Information Hub, formerly the Rural Assistance Center, is funded by the Federal Office of Rural Health Policy to be a national clearinghouse on rural health issues and provides case studies, models, tools, and more to give communities and organizations tools to utilize in local areas – and information is available by topic and state.  Model and project examples are Contingency Management Smoking Cessation in Appalachia and Community Health Worker-based Chronic Care Management Program. 


Rural healthcare is a pressing issue in the United States, which requires innovative and comprehensive plans and approaches.  Investing in strategies and solutions that manage people of all ages, including working with children to break the generational cycles, are critical to long term success.  Economic, geographic, and sociocultural themes are consistent across the country; but the uniqueness of region, state, and community is what drives the importance of local design and implementation.