The Health Care Views and Experiences of Rural Americans: Findings from the Kaiser Family Foundation/Washington Post Survey of Rural America

Appendix B: How We Defined Rural Areas and Who Lives There

Researchers use different definitions of urban and rural areas depending on the purpose of their research. For this project, we used the National Center for Health Statistics’ Urban-Rural Classification Scheme for Counties, which was developed for use in studying associations between urbanization and health, and for monitoring the health of urban and rural residents.¹ The classification breaks counties into 6 categories, ranging from the most urban to the most rural. For purposes of this analysis, the 3 most rural categories (noncore, micropolitan, and small metro) were considered rural or small town (in this report, the term “rural” encompasses both rural areas and small towns).² Just under one-quarter (23 percent) of the U.S. population lives in counties meeting this definition.

Compared with those living in urban and suburban areas, rural residents are more likely to be ages 65 and older, and less likely to have a 4-year college degree. They are also less racially diverse than urban and suburban residents; roughly eight in ten are non-Hispanic whites.

The survey also finds that those who live in rural areas report somewhat poorer health than their urban counterparts. Almost six in ten urban residents (58 percent) rate their own health as “excellent” or “very good” compared with 47 percent of those in rural areas, while rural residents are more likely than urban residents to say their health is “only fair” or “poor” (23 percent versus 15 percent).