Most rural Americans, broadly defined, are happy with their quality of life, but many face problems getting health care

Most rural Americans, broadly defined, are satisfied with their quality of life. But most also say their local economy isn't in good shape, and 40% say they've had trouble affording food, housing or medical bills in the past few years. So says the second part of the "Life in Rural America" survey by NPR, Harvard University's T.H. Chan School of Public Health, and the Robert Wood Johnson Foundation, released today. The first part was released last October.

The second survey was conducted via cell phones and landlines from Jan. 31 to March 2, among a nationally representative sample of 1,405 adults living in the rural U.S. The poll defined rurality as areas outside a Metropolitan Statistical Area, which must have a city of at least 50,000 people.

Almost half of the survey respondents reported being financially insecure: 49% said they couldn't afford to quickly pay off an unexpected $1,000 expense. 

Health-care access remains a problem in rural America, too. Though most rural Americans have health insurance, about a quarter of respondents said they haven't been able to get health care they needed at some point in the past few years. And nearly one in 10 said their local hospital has closed in the past few years. 

Homelessness and inadequate housing are also recurring issues for rural Americans. One in three respondents said homelessness is a problem in their local community, and more than one in 10 have experienced problems with their housing such as mold or unsafe drinking water. 

One-fifth of respondents said they have difficulty accessing broadband internet. Most respondents who use the internet said they mostly used it to get health-related information, for personal finance, and for job-related activities. 

People with disabilities, racial/ethnic minorities, people with a lower education level and people with disabilities all reported greater difficulties across many parts of their lives.

Though the survey found many areas of concern in rural America, it also reflected a populace that is highly civically and socially engaged, who value their rural lifestyle and see their communities as safe.