Rural health care presents unique challenges and opportunities that require thoughtful approaches. As clinicians, we can make significant impacts on rural health outcomes by considering patients’ whole health—body, mind, and spirit.
Understanding Rural Health Care
When it comes to health care, what exactly counts as a rural area? There are several ways to define rurality, even within the U.S. government. The Federal Office of Rural Health Policy offers some useful tools. Factors in determining whether your patients live in a rural area include proximity to a metropolitan area with 50,000 people or more; whether the access roads are rugged; and the number of people per square mile.
In general, about 20% of Americans live in rural areas. These areas also have fewer clinicians. For example, rural areas have just 40 primary care physicians per 100,000 residents compared to 53 in urban areas. (Rural communities also have fewer specialists.) Similarly, there are only 22 general dentists per 100,000 residents in rural areas versus 30 per 100,000 in urban communities.1,2
Rural residents are also older, on average, than people in urban and suburban areas, meaning they are more likely to have the health concerns that are part of the aging process. Also in part because they are older (more retirees), they typically have lower incomes (on average $9,242 lower per capita than the national average). Some may be agricultural workers with lower incomes, so approximately 25% of rural children live below the U.S. federal poverty line.1
From a whole person health perspective, rural environments offer some unique health benefits. Natural settings actively reduce stress and support healing—even 20 minutes outdoors daily measurably lowers blood pressure and boosts immunity. The seasonal rhythms of rural life also provide psychological security and physical engagement that support wellbeing.
Smaller rural communities are often tightly knit, with established families and well-known common gathering areas such as restaurants, clubs, and churches or organizations, such as the Veterans of Foreign Wars or Grange, providing social support and a sense of belonging that urban residents may lack.
Embracing Whole Person Care
A whole person approach means addressing not just physical health but also mental, emotional, spiritual, and social wellbeing—recognizing that 80% of health outcomes are shaped by factors outside of medical care. As clinicians, we have a responsibility to serve the specific needs of rural patients while considering their whole health—body, mind, and spirit.
Even with geographic and resource limitations, we can make significant impacts on rural health outcomes through comprehensive, patient-centered care. Using the Primary Care Personal Health Inventory tool or the HOPE Note can help you focus on what each patient wants most from their health care, which might not be what you think.
Physical Health Needs
For physical wellbeing, consider community-based exercise programs. Research from rural Japan demonstrates that exercise interventions can effectively reduce frailty in older adults.3 These programs can be led by community workers in collaboration with clinicians. As a clinician, you can ask about and recommend available programs during patient visits and follow up on participation during subsequent appointments.
Nutrition also plays a crucial role in rural health. In the United States, many rural households rely on SNAP benefits (14.6% compared to 10.9% in metropolitan areas).1 These programs are currently under scrutiny for supporting the purchase of ultra-processed food, the consumption of which can lead to worse health.4 As clinicians, we should be familiar with local food assistance programs that provide cooking tips and education on anti-inflammatory diets.
The How We Heal Campaign offers numerous free, downloadable resources, including guides to nutrition, stress, menopause, healthy aging, and more.
Mental and Emotional Wellbeing
Rural patients face unique mental health challenges, often exacerbated by isolation and limited access to mental health services. Telehealth is a promising solution, although some planned government programs have not materialized (such as the 2021 Broadband Equity, Access and Deployment Program, which has unfortunately not connected a single user). Private companies have made significant strides in connecting rural residents.5
Whether you see rural patients in virtual visits or in person, consider integrating brief mental health screenings into routine visits and helping patients find online mental and emotional health assistance when in-person options are limited. (For example, there may be therapists in your patient’s town, but all their practices may be at capacity.) Simple interventions like teaching mindfulness techniques or stress reduction strategies can also provide valuable support.
Important cultural considerations for mental wellbeing include:
- Rural older men have 50% higher suicide rates compared to their urban counterparts.
- Stigma around seeking help may be more pronounced than in urban areas.
You can help patients access the healing power of relationships, even when no mental health clinician is readily available.
Spiritual and Social Dimensions
Spiritual care is an often overlooked but essential component of whole person health. Research indicates that 69% of small and critical access hospitals offer spiritual care from professional chaplains at least three days per week.6 When available, these services can provide crucial support for patients navigating health challenges.
Social connections are equally important. Familiarize yourself with platforms like CaringBridge, which helps patients communicate about their health journey with loved ones, bridging the gap between those needing help in rural areas and those wanting to provide support from farther away.7 Such resources can be particularly valuable in reducing isolation for rural patients and improving quality of life for the caregiver.
You may want to suggest that patients seeking spiritual support investigate online options if their small town or rural area does not have a dojo, synagogue, church of their denomination, or other spiritual community. Since the COVID-19 pandemic, many social gatherings, such as Meetups and online book clubs, and houses of worship are offering virtual options.
Resources for Your Patients
Direct your patients to valuable support resources:
- Our free, downloadable Rural Health Pocket Guide
- CaringBridge helps patients share their health journey and coordinate support from family and friends
- Good Days provides resources for life-saving and life-extending treatments for those with chronic illnesses
- Local exercise programs and community health initiatives
- Virtual support groups for specific health conditions
- Transportation assistance programs available in your region
As clinicians, we may not be able to eliminate all rural health care disparities, but through thoughtful, comprehensive care strategies, we can make meaningful differences in our patients’ lives. By seeing and treating the whole person—not just their physical needs—we honor the core values of our profession and help create healthier rural communities.
References
- National Rural Health Association. About Rural Health Care. Available at https://www.ruralhealth.us/about-us/about-rural-health-care. Accessed May 7, 2025.
- Rural Health Information Hub. Healthcare Access in Rural Communities. Available at https://www.ruralhealthinfo.org/topics/healthcare-access. Accessed May 7, 2025.
- Ohta R, Sano C. Establishing Exercise Programs in Rural Settings Through Collaboration With Family Physicians. Cureus. 2023 May 10;15(5):e38814. doi: 10.7759/cureus.38814. PMID: 37303446; PMCID: PMC10251308. Available at https://pmc.ncbi.nlm.nih.gov/articles/PMC10251308/
- Ciesielski TH, Ngendahimana DK, Roche A, Williams SM, Freedman DA. Elevated dietary inflammation among supplemental nutrition assistance program recipients provides targets for precision public health intervention. Am J Prev Med. 2021 Aug;61(2):192-200. doi: 10.1016/j.amepre.2021.02.007. Epub 2021 May 11. PMID: 33985837; PMCID: PMC8319049.
- Kimball D. The $42 billion internet program that has connected 0 people. Washington Policy Center, September 18, 2024. Available at https://www.washingtonpolicy.org/publications/detail/the-42-billion-internet-program-that-has-connected-0-people. Accessed May 7, 2025.
- Schenk K, Whipkey T, Fitchett G. Mapping spiritual care in small and critical access hospitals in a faith-based US Health system. J Health Care Chaplain. 2024 Oct-Dec;30(4):255-277. doi: 10.1080/08854726.2024.2354006. Epub 2024 Jun 21. PMID: 38905273.
- CaringBridge. www.caringbridge.org. Accessed May 13, 2025.
—
Photo by Alek Newton on Unsplash