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Rural Communities

In 2024, approximately 55 million people in the United States live in rural areas – about 17% of the population. Individuals living in rural areas may experience greater health care challenges compared to individuals living in urban areas. They report poorer physical and mental health and have lower incomes and higher rates of poverty than individuals living in urban areas. Additionally, individuals in rural areas may have less access to health care services due, in part, to due to workforce shortages, long travel times to medical facilities, and rural hospital closures.

This data collection provides state-specific data on rural areas across a range of demographic and health topics, including population demographics, health insurance coverage, and health care providers. There are many methodologies for defining rural areas, and different methods are used for the indicators included in this data collection. The method used for each group of indicators is explained below.

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Population

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Health Coverage

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Disability

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Marketplace

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Medicaid

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Nursing Facilities

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Rural Health Clinics

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About this Data Collection

Methods Used to Define Rural for the Indicators in This Collection

Demographics, Health Coverage, and Disability

Locality is categorized as urban and rural. Population estimates use 2024 American Community Survey (ACS) 1-year estimates, along with zip codes and zip code equivalents based on 2020 Rural-Urban Commuting Area (RUCA) Codes from the U.S. Department of Agriculture to define locality. A PUMA-to-zip code crosswalk was obtained from the Missouri Census Data Center. Urban areas, or metropolitan areas, are defined as zip codes with a primary RUCA code of 1, 2, or 3. Rural areas include zip codes with a primary RUCA code of 4 through 10, representing micropolitan, small town, and remote rural areas. 

Marketplace

The Marketplace Open Enrollment Period Public Use Files uses zip codes or zip codes and counties, as defined by the Health Resources and Service Administration (HRSA), to identify individuals who live in rural and non-rural (urban) locations in states using the Healthcare.gov platform only.   

Medicaid

Locality for births is categorized as metropolitan (metro) and rural areas (nonmetro). The Metro group includes counties in these Urbanization categories: Large Central Metro, Large Fringe Metro, Medium Metro, and Small Metro. The Nonmetro group includes counties in these Urbanization categories: Micropolitan (non-metro) and NonCore (non-metro) using the 2013 NCHS Urban-Rural Classification Scheme for Counties. 

Providers

• Nursing Facilities in Rural Areas : Nursing homes in urban areas are defined as those in metropolitan areas, while nursing homes in rural areas are defined as those in nonmetropolitan areas. A metropolitan area is a county or group of counties that contains at least one urban area with a population of 50,000 or more people. Nonmetropolitan areas include micropolitan areas—which are counties or groups of counties that contain at least one urban area with a population of at least 10,000 but less than 50,000—and noncore areas (areas that are neither metropolitan nor micropolitan). Counties and county equivalents are based on 2024 Urban Influence Codes from the USDA. 

• Rural Health Clinics: For a clinic to be certified as a Rural Health Center, it must be in an area defined by the U.S. Census Bureau as non-urbanized and be currently designated by the Health Resources & Services Administration within the last 4 years as 1 of these: Primary Care Geographic Health Professional Shortage Area (HPSA), Primary Care Population Group HPSA, Medically Underserved Area, Governor-Designated and Secretary-Certified Shortage Area.