Disparities exist in the livelihood and opportunities for people living in America’s rural communities. These differences result in a much sicker rural America compared to its urban counterpart. Rural counties have higher rates of smoking, obesity, child poverty, and teen pregnancies than urban counties. More uninsured adults live in rural areas, causing rural hospitals to close and/or cut vital services such as obstetrics care. Rural hospitals also provide fewer mental health services. The result is Americans living in rural areas are more likely to die from the five leading causes of death than those living in urban areas: heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke. Depending on the definition of rural, between 46-60 million people, or approximately 15-20 percent of the U.S. population, live in rural communities. Rural communities exist in nearly every state with great variability in their culture, economics, and social conditions. In fact, 97 percent of the country’s land mass is rural.

This paper aims to provide a framework for policy solutions to build a healthier rural America. First, the authors describe in detail the health challenges occurring in rural communities and the great disparity that exists between rural and urban health measures. Second, they describe the varying definitions of rural and how this inconsistency in definition leads to greater difficulties in solution design. Third, the authors describe the current state of rural health policy, especially as it relates to current payment mechanisms for hospitals and providers. Finally, they describe innovative policies and practices in states addressing rural health challenges and how many of them could be a model for the country.