Policy Document Series · Issue 42 of 45 · Communities & Governance
Rural America
Rebuilding the Communities That Feed and Power the Nation
46 million Americans live in rural communities that produce the food, energy, and raw materials the nation depends on. In return, they get closed hospitals, no broadband, and policies designed for cities. More than 180 rural hospitals have shut down since 2005 and 700 more are at risk. This is not neglect. It is abandonment by design.
180+
Rural hospitals closed since 2005 — 700+ more at risk
21%
Of rural Americans lack broadband — vs. 1% urban
-2.3M
Rural population loss 2010–2020 — brain drain accelerating
58.1 yrs
Average age of U.S. farm operator — under-35s: fewer than 9%
Rural America is not a flyover. It is the foundation. 46 million people on 72% of the land, producing the food, energy, and resources the nation cannot function without. Yet more than 180 rural hospitals have closed since 2005. 21% of rural Americans lack broadband. Rural counties lost 2.3 million people in a single decade. The poverty rate runs 30% higher than urban areas. The average farm operator is 58 years old and the next generation cannot afford to start.
Rural Physicians per 100,000
65
Nearly half the physician density of urban areas. Maternity wards closing. ER closures raise mortality 8.7%.
Urban Physicians per 100,000
100+
Urban Americans have access to specialists, emergency care, and maternity services that rural communities have lost.
Eight pillars rebuilding rural America: stabilize every at-risk rural hospital, deliver universal broadband by 2032, revive family farms and break meatpacking monopolies, recruit rural doctors and teachers through loan forgiveness, make clean energy a rural economic engine, invest in rural schools, deploy an opioid and mental health response, and rebuild rural transportation and infrastructure.
Rural America is not declining by accident. It is declining because policy decisions — on healthcare reimbursement, broadband deployment, agriculture subsidies, and education funding — have systematically favored urban and suburban populations for decades.
More than 180 rural hospitals have closed since 2005, and the Chartis Center for Rural Health identifies over 700 more at financial risk. Rural Americans face a physician shortage nearly twice as severe as urban areas — 65 primary care physicians per 100,000 residents versus 100+ in cities. Emergency departments are closing, maternity wards are disappearing, and the average drive to the nearest hospital keeps growing. When a rural ER closes, mortality from time-sensitive conditions rises 8.7% (JAMA Internal Medicine, 2023).
21% of rural Americans lack broadband internet access, compared to just 1% of urban residents (FCC 2024 Broadband Deployment Report). Without broadband, telehealth is unavailable, remote work is impossible, children cannot do homework, and small businesses cannot compete. Billions in federal broadband subsidies have been spent, but coverage maps remain unreliable and deployment has favored easy-to-reach areas over the communities that need it most.
Rural counties lost 2.3 million people between 2010 and 2020 (U.S. Census Bureau). Young adults leave for education and jobs, and few return. The average farm operator is 58.1 years old (USDA Census of Agriculture 2022). Rural poverty stands at 15.4%, compared to 11.9% in urban areas (USDA Economic Research Service). The opioid crisis has hit rural communities disproportionately — rural overdose death rates now exceed urban rates for the first time, driven by limited treatment access and long EMS response times.
Agriculture consolidation has gutted the family farm economy. Four companies control 85% of beef processing. The top 10% of farms capture 78% of federal subsidies. Beginning farmers face land costs that have tripled in two decades while commodity prices stagnate. Rural schools face chronic teacher shortages — 9% vacancy rate versus 5% nationally — and school consolidation forces children into hour-long bus rides. The communities that feed and power the nation are being hollowed out.
Sources: Chartis Center for Rural Health — Rural Hospital Closures ·
FCC 2024 Broadband Deployment Report ·
USDA ERS — Rural Poverty ·
USDA Census of Agriculture 2022 ·
Census Bureau — Rural Population Trends ·
JAMA Internal Medicine (2023) — Rural ER Mortality Impact
The rural crisis did not emerge from market forces alone. It was built by policy choices that concentrated investment in urban centers and left rural communities to absorb the costs of extraction — agricultural, energy, and human.
Healthcare reimbursement policy is the single largest driver of rural hospital failure. Medicare reimburses rural hospitals at lower rates than urban facilities for the same procedures. States that refused Medicaid expansion — disproportionately rural, Southern states — left hospitals with uncompensated care burdens that make financial viability impossible. The Critical Access Hospital designation helps but is underfunded and covers too few facilities. Rural hospitals close not because they are unnecessary but because the payment system makes them unprofitable.
Broadband deployment followed profit, not need. Telecom companies invested in dense suburban and urban markets where per-customer costs are lowest. Federal broadband subsidies relied on carrier self-reported coverage maps that systematically overstated rural access. The result: billions spent, millions still unconnected. States lobbied by telecom companies passed laws banning municipal broadband — preventing communities from solving the problem themselves.
Agricultural policy consolidated farming into fewer, larger operations. Federal subsidies flow overwhelmingly to the largest producers — the top 10% of farms capture 78% of commodity payments. Beginning farmers face triple-the-cost land markets with limited federal support. Meatpacking consolidation (four firms: 85% of beef) gives processors monopsony power over cattle ranchers, who now receive less than 30 cents of every retail beef dollar (see Issue #26). Trade policy opened export markets for grain but did nothing to protect small producers from import competition or price volatility.
Sources: HRSA — Health Professional Shortage Areas ·
FCC — Broadband Coverage Methodology ·
USDA Census of Agriculture 2022
Peer democracies with comparable geography treat rural communities as essential infrastructure — not as afterthoughts. The US is the outlier: the richest country in history that cannot keep rural hospitals open or deliver broadband to 21% of its rural population.
| Country |
Rural Health |
Broadband |
Key Feature |
| European Union |
Universal coverage |
~95%+ |
Common Agricultural Policy: €387B (2021–2027), 30% tied to rural development |
| Australia |
Royal Flying Doctor Service |
~87% |
Bonded rural health scholarships; 7.3M km² covered by integrated rural health |
| Denmark |
Universal + mobile clinics |
98% |
Municipal broadband cooperatives; universal fiber obligation even in rural areas |
| Canada |
Universal + incentives |
~93% |
Universal Broadband Fund; rural physician loan forgiveness; 98% target by 2027 |
| New Zealand |
Rural Health Alliance |
~90% |
Dedicated rural practice subsidies; integrated telehealth networks |
| United States |
180+ hospitals closed |
79% |
Lowest rural broadband among peers; no universal rural health mandate; 2.3M people lost |
The EU's Common Agricultural Policy allocates €387 billion over 2021–2027 with 30% explicitly directed to rural development — not just farm subsidies but infrastructure, broadband, healthcare, and community investment. Denmark achieves 98% rural broadband coverage through municipal cooperatives. Australia covers 7.3 million square kilometers of outback with the Royal Flying Doctor Service and bonded rural health scholarships. No peer democracy treats its rural communities the way America does.
The rural-urban divide in key metrics:
| Metric |
Rural US |
Urban US / Peer Nations |
| Primary care docs per 100K |
65 |
100+ (Urban US) |
| Broadband access |
79% |
99% (Urban US) |
| Poverty rate |
15.4% |
11.9% (Urban US) |
| Population change 2010–2020 |
−2.3M |
+19.6M (Metro US) |
Sources: European Commission — Common Agricultural Policy ·
FCC — Broadband Deployment ·
HRSA — Health Workforce Shortage Areas
Eight pillars rebuilding rural America — hospital stabilization, universal broadband, rural workforce recruitment, family farm revival, clean energy as rural jobs, rural education investment, opioid and mental health response, and rural transportation and infrastructure.
180+ closed since 2005 · 700+ at risk · rural ER closure raises mortality 8.7% · 65 docs per 100K vs. 100+ urban
- Emergency operating subsidies for all 700+ at-risk rural hospitals. No more closures while long-term reform is built. Facilities stay open and staffed while the payment system is restructured.
- Expand Rural Emergency Hospital (REH) designation with full funding. Increase Critical Access Hospital reimbursement to cost-plus. Mandate Medicaid expansion acceptance as a condition of federal hospital funding — states that refuse expansion force rural hospitals to absorb uncompensated care costs that make survival impossible (see Issue #1).
- Telehealth parity: Medicare and Medicaid reimburse telehealth visits at the same rate as in-person visits, permanently. COVID-era flexibilities made permanent. Rural patients should not pay a penalty for geography.
- Target: zero net rural hospital closures within 5 years. When a rural ER closes, mortality from time-sensitive conditions rises 8.7%. This is a life-and-death emergency, and the federal response must match.
21% without broadband vs. 1% urban · $65B annual economic opportunity · broadband gap closes remote work, telehealth, precision ag
- Fiber-to-home for every rural address by 2032. $50 billion Universal Broadband Fund (see Issue #25). 100/100 Mbps symmetric minimum standard — no more defining "broadband" down to justify inadequate satellite service.
- Preempt state bans on municipal and cooperative broadband. 18 states currently restrict communities from building their own networks — laws passed at the behest of telecom incumbents. Communities that want to solve the problem must be allowed to solve it.
- Fix coverage maps with ground-truth audits. Replace carrier self-reporting with independent speed-testing and coverage verification. Accurate maps within 12 months. No more funding based on fiction.
- Rural Broadband Cooperative model: allow communities to build, own, and operate their broadband networks with federal startup grants and technical assistance. Denmark achieves 98% rural coverage through this model.
65 docs per 100K rural vs. 100+ urban · 9% teacher vacancy rate vs. 5% nationally · loan forgiveness + housing = recruitment
- Full student loan forgiveness for physicians, nurses, and teachers who serve 5+ years in rural shortage areas. Expand National Health Service Corps loan repayment to $100,000. Existing participants grandfathered at the higher amount.
- Fund 5,000 new rural residency slots. Build the pipeline at the source — physicians who train in rural areas are far more likely to practice there. Community health worker certification and reimbursement to extend care teams.
- Rural teacher housing assistance: down payment grants and rental subsidies for teachers in communities where housing costs exceed local salary levels. Rural schools cannot recruit when teachers cannot afford to live.
4 companies: 85% of beef processing · top 10% of farms: 78% of subsidies · average operator age: 58.1 · ranchers get <30 cents per beef dollar
- Subsidy reform: cap commodity payments at $50,000 per farm per year, $125,000 individual maximum. Redirect 40% of farm subsidies to small and mid-size operations that currently receive almost nothing (see Issue #26).
- Beginning Farmer Program ($500M/year): land access, low-interest loans, mentorship, and business planning. The average farm operator is 58.1 years old. Fewer than 9% are under 35. Without a next generation, rural America has no future.
- Break up meatpacking monopolies: maximum 25% market share per company in any processing sector. Cattle ranchers currently receive less than 30 cents per retail beef dollar — the rest goes to four processors that control 85% of the market.
- Right to repair farm equipment. End the John Deere monopoly on equipment servicing. Farmers own their equipment — they should be able to fix it.
Rural communities host wind, solar, and transmission — they should own the upside · $10B rural clean energy co-op fund
- Community benefit agreements required for all energy projects on rural land. Lease payments, royalty sharing, local hiring requirements, and community investment funds — not just a check to the landowner while the county gets nothing.
- Rural Clean Energy Cooperative Fund ($10B): startup capital for community-owned wind, solar, and battery storage projects. Rural communities host the energy infrastructure — they should own a share of it (see Issue #11).
- Prioritize rural areas for grid modernization jobs. Transmission line construction, substation upgrades, and battery storage installation create long-term, well-paying jobs in the communities where the infrastructure is built.
- Just Transition payments for fossil fuel communities. Workers and communities dependent on coal, oil, and gas receive direct economic support during the energy transition — not abandonment.
9% teacher vacancy rate vs. 5% nationally · school consolidation = hour-long bus rides · lowest pre-K enrollment in the nation
- End school consolidation mandates. $5 billion rural school modernization fund for facilities, technology, and program expansion. Rural schools serve as community anchors — closing them accelerates the brain drain.
- Universal pre-K in rural districts. Rural children currently have the lowest pre-K enrollment rates in the nation. Early childhood education has the highest return on investment of any education spending (see Issue #4).
- Career and technical education expansion tied to local economies. Programs linked to agriculture, energy, healthcare, and trades — not just college preparation. Rural students need pathways that keep them connected to their communities.
- High-speed broadband in every rural school. Distance learning, dual enrollment, and specialized coursework become possible only with reliable internet access.
Rural overdose death rates now exceed urban · treatment wait times: 30+ days in most rural counties · limited behavioral health providers
- Medication-assisted treatment (MAT) available at every rural health clinic. No rural patient should wait 30+ days for addiction treatment because the nearest provider is 100 miles away. Expand buprenorphine prescribing authority.
- Mobile crisis units for counties without behavioral health providers. Deploy teams that travel to patients rather than requiring patients to travel to care — the Australian Royal Flying Doctor model adapted for mental health.
- Expand 988 Suicide & Crisis Lifeline rural capacity. Rural counties have the highest suicide rates in the nation. Staffing and response times must match the need (see Issue #39).
- Fund rural substance abuse treatment beds. Current wait times exceed 30 days in most rural counties. Build capacity where the crisis is worst, not where it is most convenient (see Issue #19).
42% of rural bridges structurally deficient or functionally obsolete · disproportionate traffic fatality rate · limited transit options
- Fix rural bridges: 42% are structurally deficient or functionally obsolete. Dedicated federal infrastructure investment for rural road and bridge repair (see Issue #25).
- Expand rural public transit. Rural transit grants for demand-responsive and fixed-route service. Not every community needs a subway — but every community needs a way to get to the hospital, the grocery store, and the school.
- Restore Essential Air Service funding. Rural communities that lost commercial air service need reliable connections to regional hubs — for medical emergencies, business travel, and economic viability.
- Rural water and wastewater investment. Aging systems in small towns face compliance costs they cannot afford alone. Federal grants — not just loans — for communities under 10,000 population.
Sources: Chartis Center for Rural Health ·
FCC 2024 Broadband Deployment ·
USDA Census of Agriculture 2022 ·
USDA ERS — Rural Poverty & Well-Being ·
European Commission — CAP ·
HRSA — Shortage Areas
Rural disinvestment is not free. Taxpayers already pay for closed hospitals through longer EMS transports, higher mortality, and emergency room visits 100 miles away. They pay for the broadband gap through lost economic output. They pay for farm consolidation through SNAP and commodity subsidies that flow to the largest operations. Every reform here either saves money, generates returns, or is funded by redirecting existing misspent resources.
| Component |
Funding |
Notes |
| Rural hospital stabilization |
Medicaid expansion + reimbursement reform |
States that expanded Medicaid saw rural hospital closure rates drop significantly. Uncompensated care costs shift from hospitals to the federal system. |
| Universal broadband ($50B) |
Issue #25 infrastructure revenue + spectrum auction proceeds |
FCC estimates $65B in annual economic activity from closing the rural broadband gap. $1.54 GDP return per $1 of rural infrastructure spending. |
| Physician & Teacher Corps |
Expanded NHSC + education funding |
Loan forgiveness costs offset by reduced vacancy-related expenses and improved health outcomes in shortage areas. |
| Farm subsidy reform |
Redirection of existing subsidies |
No new money — redirect from top 10% of farms (78% of payments) to beginning farmers and small/mid-size operations. |
| Clean energy co-op fund ($10B) |
Issue #11 clean energy revenue + DOE grants |
Revenue-generating investment. Community-owned energy projects create sustained county revenue streams. |
| Rural schools ($5B) |
Issue #4 education revenue |
Highest ROI in education spending. Universal pre-K alone returns $7+ per $1 invested (see Issue #4). |
| Opioid & mental health |
Issue #19 + pharmaceutical settlements |
Opioid settlement funds directed to rural treatment infrastructure. Prevention is cheaper than emergency response. |
| Rural infrastructure |
Issue #25 infrastructure revenue |
13,000–25,000 jobs per $1B in rural infrastructure investment. Economic multiplier effect offsets direct costs. |
Phase 1 — Day 1 to Month 6
Emergency Stabilization
Emergency rural hospital stabilization fund activated — all 700+ at-risk facilities protected. Telehealth parity executive order issued. NHSC rural loan repayment expanded to $100K. Broadband coverage map audit ordered. Emergency MAT distribution to rural health clinics. Clean energy community benefit requirement for new federal permits.
Phase 2 — Month 6 to Year 1
Legislative Foundation
Rural Hospital Stabilization Act introduced with bipartisan sponsors. Universal Broadband Fund authorized ($50B). State municipal broadband bans preempted. Farm subsidy reform legislation introduced. Beginning Farmer Program funded at $500M/year. 5,000 new rural residency slots authorized.
Phase 3 — Year 1 to Year 3
Deployment and Build-Out
Broadband deployment begins in highest-need areas. Rural school modernization fund distributes first grants. Clean Energy Cooperative Fund launches ($10B). Meatpacking antitrust enforcement actions initiated. Mobile crisis units deployed to underserved counties. Rural teacher housing assistance program operational.
Phase 4 — Year 3 to Year 5
Universal Coverage and Measurement
Universal broadband target: every rural address by 2032. Zero net rural hospital closures achieved. Rural physician density reaches 85+ per 100,000. Beginning farmer enrollment measured against average operator age baseline. Rural broadband economic impact measured against the FCC's $65B projection. Opioid treatment wait times measured against 30-day baseline.
"Rural decline is just market forces at work. People are moving to cities because that is where the opportunity is."
People move to cities because that is where the investment is — and the investment follows policy, not destiny. The EU invests €387 billion in rural development. Denmark achieves 98% rural broadband. Australia sends doctors to the outback. The US chose to disinvest in rural communities, and the migration followed. When you close the hospital, shut down the school, and refuse to build broadband, people leave. That is not a market signal. It is a policy outcome.
"Farm subsidies already cost too much. Why redirect them instead of cutting them?"
The problem is not the total amount — it is the distribution. 78% of commodity payments go to the top 10% of farms. The largest operations do not need subsidies to survive. Beginning farmers and small producers do. Redirecting subsidies from industrial agriculture to beginning farmers and conservation is not adding spending — it is spending the same money on the people and practices that actually need support. The EU does this with its Common Agricultural Policy. It works.
"Universal broadband is too expensive for low-density areas. The market will get there eventually."
The market has had 25 years to "get there." 21% of rural Americans still lack broadband. Telecom companies took billions in federal subsidies and deployed in profitable suburban areas instead. Denmark solved this through municipal cooperatives. Canada is targeting 98% coverage by 2027. The FCC estimates that closing the rural broadband gap would generate $65 billion in annual economic activity. The return dwarfs the cost — the market failure is clear and will not self-correct.
"Breaking up meatpacking companies will raise food prices."
Meatpacking consolidation has already raised food prices — for consumers — while suppressing prices for ranchers. Four companies control 85% of beef processing and have used that market power to widen the spread between what consumers pay and what ranchers receive. Cattle ranchers get less than 30 cents per retail beef dollar. Restoring competition means ranchers get a fair price and consumers benefit from competitive markets rather than oligopoly pricing (see Issue #26).
"Rural hospitals close because there are not enough patients to justify them."
Rural hospitals close because the payment system underfunds them, not because patients do not exist. When a rural ER closes, mortality from time-sensitive conditions rises 8.7% (JAMA, 2023). The patients are there. The emergencies are there. The births are there. States that expanded Medicaid saw dramatically lower rural hospital closure rates because the fundamental economics changed. This is a reimbursement policy problem, not a demand problem.
What this platform does — every commitment in plain language:
| Action |
Detail |
| Hospital stabilization | Emergency subsidies for 700+ at-risk facilities; telehealth parity; Medicaid expansion mandate |
| Universal broadband | Fiber-to-home by 2032; $50B fund; preempt municipal broadband bans; 100/100 Mbps minimum |
| Physician & Teacher Corps | Full loan forgiveness for 5+ year rural service; 5,000 new residency slots; teacher housing |
| Family farm revival | Subsidy caps + redirection; $500M/yr beginning farmer program; meatpacking divestiture (25% max) |
| Clean energy | Community benefit agreements; $10B co-op fund; grid modernization jobs; Just Transition payments |
| Rural education | End consolidation mandates; $5B school fund; universal pre-K; career & technical education |
| Opioid & mental health | MAT at every clinic; mobile crisis units; 988 rural capacity; treatment bed funding |
| Infrastructure | Fix 42% deficient bridges; rural transit; Essential Air Service; water/wastewater grants |
Issue 1
HealthcareSingle-payer eliminates the reimbursement disparity that drives rural hospital closures. Universal coverage means no more uncompensated care burdens.
Issue 4
EducationRural education funding, universal pre-K, and teacher recruitment are inseparable from the broader education equity agenda.
Issue 11
Climate & EnergyThe clean energy transition is rural America's next economic engine — if community benefit agreements and cooperative ownership ensure the revenue stays local.
Issue 14
TradeTrade policy that opened export markets for grain but failed to protect small producers from price volatility and import competition. Fair trade = fair farming.
Issue 25
InfrastructureRural broadband, bridge repair, water systems, and transit are components of the national infrastructure investment. 13,000–25,000 jobs per $1B spent.
Issue 26
Food & AgricultureMeatpacking antitrust, subsidy reform, beginning farmer support, and right to repair are shared pillars between rural America and food policy.
"Rural America does not need charity. It needs the same investment in hospitals, broadband, schools, and infrastructure that the rest of the country takes for granted. 46 million people on 72% of the land, producing the food, energy, and resources the nation cannot function without. When rural communities fail, the whole country feels it. These communities feed and power the nation — it is time policy returned the favor."
— The Common Good Party
Paid for by The Common Good Party (thecommongoodparty.com) and not authorized by any candidate or candidate's committee.