Tanisa Adimu, Associate Project Director, Georgia Health Policy Center
John Butts, Senior Research Associate, Georgia Health Policy Center
Amy Elizondo, Chief Strategy Officer, National Rural Health Association
Carla Freeman, Senior Research Associate, Georgia Health Policy Center
Cara V. James, President and CEO, Grantmakers In Health
Ana LaBoy, Senior Research Associate, Georgia Health Policy Center
Amanda Phillips Martinez, Associate Project Director, Georgia Health Policy Center
Colin Pekruhn, Program Director, Grantmakers In Health
Accessing health care and the social conditions required for well-being remains a challenge in many rural communities. Persistent workforce shortages, lower rates of insurance coverage, higher rates of unemployment, and limited infrastructure (e.g., broadband and transportation) contribute to higher levels of physical and mental health issues in rural areas. Yet rural communities consistently demonstrate resilience and the ability to build innovative partnerships that strengthen resource-constrained health systems.
To inform positive change, Grantmakers in Health (GIH) and the National Rural Health Association (NRHA) are partnering to reimagine a unified vision for health and well-being in rural America. The Georgia Health Policy Center (GHPC) was engaged to conduct a landscape analysis and facilitate listening sessions with rural health stakeholders at the local, state, and national levels. This work took place during a time of significant federal policy and funding shifts, including passage of H.R. 1, the 2025 budget reconciliation bill. While concerns about the implications of these changes were front-and-center, findings reaffirmed that aligning systems, listening deeply to local needs, and investing in long-term, community-driven solutions remain essential for advancing rural health.
Landscape Analysis: GHPC conducted a landscape analysis and key informant interviews between February and April 2025 to capture a snapshot of effective practices of funders (public and private), program implementers (including federally funded grantees, nonprofits, and providers), and support organizations (e.g., state public health institutes, nonprofit organizations, and rural research centers) in rural areas.
Listening Sessions: GHPC facilitated two listening sessions—an in-person session in May 2025 (before H.R.1) with 12 representatives from public and private funders and health systems, and a virtual session in July 2025 (post H.R.1) with 21 program implementers from health care and community-based organizations.
As reflected in the landscape analysis and listening sessions, several persistent challenges emerged that continue to hinder progress toward accessible and sustainable rural health systems:
- Shortages of advanced practitioners, high burnout, and limited support for training, recruitment, and retention continue to challenge the rural health workforce.
- Access to essential health and social services, including behavioral and maternal health care, affordable housing, and nutritious food, remains fragile. Many anticipate service line reductions and an increase in hospital closures, further straining safety-net providers.
- Cuts to Medicaid and social supports are weakening trust and creating uncertainty, unraveling progress in building systems that address health and social needs of communities.
- Impending disinvestment at the federal level will negatively affect systems of care, coverage, and the health and well-being of rural populations.
Insights gleaned from the landscape analysis and listening sessions offer guidance on ways to reimagine current priorities and strategies. These include direct health care investments (e.g., increasing the capacity of the rural health workforce, leveraging telehealth and other technologies to close gaps in care, and expanding investment in mental/behavioral health and maternal health programs) along with broader consideration of the interconnected factors that shape health and well-being in rural America. Across all strategies, flexible funding and local autonomy remain essential for developing community-driven solutions that reflect the unique needs of rural areas.
Invest upstream: Increase investment in interventions that address the root causes of poor health, (e.g., economic instability, lower-quality education, and unhealthy environments) and prioritize prevention.
“It’s not just about health care – it’s about reinvesting in rural communities.”
Focus on infrastructure and economy: Concentrate on the foundational roles of infrastructure (e.g., access to broadband, transportation, and housing) and local economic conditions. Attract a broader set of funders by demonstrating the value of investing in economic development and community vitality as a path to healthier rural communities. The focus should be on economic development and investment that supports rural innovation and rural-relevant models, not trying to make rural “fit” into misaligned funding and policy structures.
Build local capacity and amplify rural voices: Funders should invest in and empower local organizations and residents through training, technical assistance, and funding. Supporting robust, local community research and evaluation can inform the development of effective rural-relevant models and future innovation. There is widespread misinformation and lack of understanding about rural health funding and the impact of policy changes on rural communities. To counter that, investment in the development of local rural leadership is needed to drive education and advocacy efforts that support rural health solutions.
A road map to a healthier future for rural Americans should build upon rural innovation and assets. The research surfaced guiding principles that can inform long-term investment in rural:
Collaborate across sectors: Rural communities draw strength from close networks, shared responsibility, and strong local engagement. Implementers emphasize cross-sector partnerships that include a wide range of stakeholders (e.g., health care, schools, local government, and faith-based groups) are a critical lever for change.
“What is best about rural is that it’s community-focused and allows for the well-being of the community.”
Design local solutions: Examples abound for how local rural communities can “grow their own” workforce (e.g., investing in community health workers), leverage existing community assets and expertise, and empower those with lived experience to shape policy.
Rethink funding models: There is a need for flexible funding models and investments that align with or adapt to the unique realities across rural communities and integrate health, economic, and social systems.
While the challenges facing rural health care systems can feel overwhelming, the capacity for rural innovation and resilience is immense. This partnership and research help illuminate a shared path forward—one that brings rural stakeholders together to align programs, policy, and funding in support of reimagining health and well-being in rural America.