New study helps explain why rural Americans die younger: chronic ills, food deserts, health-care access, outmigration

Starting in the 1990s, life expectancy in rural areas fell below that in urban areas, and "The gap keeps growing . . . mainly among prime working-age adults (ages 25–54), which has important implications for rural health, productivity, and economic development," says a new study from the University of Illinois and the Agriculture Department, which tries to explain why. 

It "points to the structural, economic, and retail environments of the counties they live in," writes C.J. Miller of Hoosier Ag Today. The increasing rural death rate is increasingly driven by chronic illnesses such as "heart disease and diabetes, rather than external crises like suicides or drug overdoses. Crucially, the study found that these health disparities largely vanish when accounting for specific county-level characteristics, suggesting that the 'place' itself dictates survival. . . . when the researchers ran linear regression models that adjusted for the local environment—including the density of grocery stores, recreational facilities, local labor force participation, and per-capita income—the statistical significance of a person’s “rural” status virtually disappeared."

Past studies have usually pointed to personal choices; this one looks at the assets (or lack of them) in rural counties that contribute to health and wellness, as Miller describes:

• Food and retail deserts: Rural counties often feature a higher concentration of fast-food establishments relative to full-service grocery stores, making nutritional compliance a geographic challenge.
• Health care access: Decades of rural hospital closures and a persistent shortage of physicians mean chronic conditions like cardiovascular disease are frequently caught later and managed poorly.
• Socioeconomic stress: Lower personal income and suppressed labor force participation rates contribute to an elevated “allostatic load”—the medical term for the cumulative biological wear-and-tear caused by chronic stress.
• Digital divide: Modern health literacy increasingly relies on a robust information environment. A lack of high-speed broadband internet in rural areas limits access to telehealth services and health education.

"The study also touched on the complicated role of internal migration, noting that urban centers frequently attract healthier, upwardly mobile individuals from rural communities — a phenomenon known as the 'healthy migrant hypothesis,' leaving behind a rural population that is older, poorer, and less biologically equipped to withstand structural neglect," Miller reports.

The study was done by researchers at UI Urbana-Champaign and the USDA's Economic Research Service and published in the peer-reviewed journal Economics & Human Biology. It used "restricted-use files from the National Health and Nutrition Examination Survey spanning 1999 to March 2020. This allowed them to link individual health metrics, including objective laboratory indicators like blood-drawn cholesterol levels and glycohemoglobin (blood sugar tracking), with the specific federal county codes of the participants," Miller reports.

Opinion: SNAP program changes may mean fewer retailers offering healthy food in rural and low-income areas

SNAP changes a may further limit access to healthy food. 
(Photo by Maria Lin Kim, Unsplash)

U.S. retailers will face new rules if they want to continue participating in the Department of Agriculture's Supplemental Nutrition Assistance Program, formerly known as food stamps. "Starting on Nov. 4, 2026, any retailers that accept SNAP benefits from their customers will have to stock a wider variety of food, some of it perishable," writes community health expert Benjamin Chrisinger in his opinion for The Conversation.

The USDA is touting its stricter requirements as a way to make healthier food more available to the roughly 38 million Americans who rely on SNAP for groceries but, as Chrisinger explains, the new rules could hurt overall grocery access because the added expense in complying with USDA changes may lead smaller stores to stop accepting SNAP.

Current USDA rules require all SNAP-participating retailers to sell at least three items in each of four staple food categories, which include dairy, produce, grains and protein. "Under the stricter new rules, all retailers accepting SNAP as payment must sell at least seven kinds of food in each of those four categories," Chrisinger writes. "And they need to offer at least one perishable variety in three of the four."

The stricter rules will not require changes from larger retailers because they already sell a wide variety of items across all USDA staple categories. But small shops and convenience stores, which are often found in rural and low-income areas, may find the changes too expensive.

"A big industry group that represents convenience stores and an anti-hunger organization are both warning that instead of making it easier for low-income people to follow a balanced diet, the new USDA rules might lead many small shops to stop accepting SNAP benefits," Chrisinger writes.

While small stores that now accept SNAP offer convenient options to area residents, getting them to stock healthier food may not happen because grocery items already have razor-thin profit margins and "many smaller retailers are not familiar with how to source and stock healthier food, especially produce," Chrisinger adds. "And many question whether these products will sell."

U.S. is suffering from a chronic disease endemic, but its prevalence and challenges are more extreme for rural folks

Chronic illness are prevalent across the U.S.
(Adobe Stock photo)

A lack of health care access, poverty and limited fresh food options means many rural Americans face a more intense battle combating chronic illnesses, many of which have become alarmingly common in the U.S. Eli Saslow of The New York Times reports, "Americans now spend more years living with chronic disease than people in 183 other countries in the World Health Organization — a reality that Robert F. Kennedy Jr. framed as a 'national crisis' in his first weeks as health secretary."

The daily work life of Sam Runyon, a traveling home health nurse in West Virginia, highlights how prevalent chronic health issues are in some rural communities. "All 31 patients in her caseload were under 65 years old, and yet each had at least one of the chronic diseases that had become endemic in the United States," Saslow writes. Runyon treats patients throughout Mingo County, "where the average life expectancy has been dropping steadily for a decade to 67 years old."

The prevalence of chronic disease deaths isn't unique to rural residents. "Death rates are up 25% nationally from diabetes, 40% from liver disease, 60% from kidney disease, 80% from hypertension and more than 95% from obesity," Saslow explains. However, rural residents can lack treatment options and financial resources that help counter chronic disease progression.

Joe Miller, 48, is one of Runyon's patients fighting chronic illness, poverty and a poor lifestyle history that can be common in many rural communities. Saslow writes, "Joe was lying shirtless on his bed, immobilized from hip pain as his pit bull chewed his socks. On his night stand was a bowl of macaroni and cheese, a box of salt. . . . [His wife] was dead of a heart attack in her 40s, and he was struggling with depression and closing in on 300 pounds with dangerously high cholesterol. . ."

Like many small towns, there is only one grocery store in Mingo County and produce is expensive, but ultra-processed foods such as soda and frozen pizza are plentiful. Health problems like Joe's have become more common among working-class Americans who are "dying at higher rates than they were 20 years earlier," Saslow adds. "People in the country’s poorest places were now almost twice as likely to develop chronic disease as those who lived in wealthy, urban centers on the coasts. . ."

Opinion: Bringing grocery stores back to poor and rural areas requires reviving a 1936 law that is now ignored

Adobe Stock photo

A change in federal policy during the 1980's created modern-day "food deserts" in poor and rural communities. While the revision was intended "to reward the biggest retail chains for their efficiency," writes Stacy Mitchell in her opinion for The Atlantic, it put local grocery stores out of business while increasing food costs in areas already hampered by poverty and depopulation. . . . "Food deserts will not go away until that mistake is reversed."

Historically, local grocery stores were shielded by the Robinson-Patman Act. "The law essentially bans price discrimination, making it illegal for suppliers to offer preferential deals and for retailers to demand them. It does, however, allow businesses to pass along legitimate savings," Mitchell explains. For more than four decades, the Robinson-Patman Act successfully maintained the delicate balance of U.S. grocery store competition between big chains and local stores.

In the 1980s, the Reagan administration didn't agree with the "tough antitrust enforcement" that previous administrations had provided through the Robinson-Patman Act, so "the government simply stopped enforcing it," Mitchell writes. "That move tipped the retail market in favor of the largest chains. . . .Walmart was the first to fully grasp the implications of the new legal terrain. It soon became notorious for aggressively strong-arming suppliers, a strategy that fueled its rapid expansion."

Once the Robinson-Patman Act was dismantled, independent grocers and smaller supply businesses couldn't compete on price and were squeezed out of their neighborhood markets. "Price discrimination spread beyond groceries, hobbling bookstores, pharmacies, and many other local businesses," Mitchell reports. "From 1982 to 2017, the market share of independent retailers shrank from 53% to 22%."

Meanwhile, mega-retailers such as Walmart and Safeway continue to dominate sales but still fail to meet needs in rural communities. Why? They don't have to. "Walmart can capture spending across a wide region by locating its supercenters in larger towns."

Stacy Mitchell
(Photo by Brian Fitzgerald via ILSR)

To create an economic atmosphere where smaller local grocers and retailers could succeed, the Robinson-Patman Act will need to be revived and applied. Mitchell adds,"Requiring a level pricing playing field would restore local retailers’ ability to compete. This would provide immediate relief to entrepreneurs who have recently opened grocery stores in food deserts, only to find that their inability to buy on the same terms as Walmart and Dollar General makes survival difficult."

Stacy Mitchell is a co-director of the Institute for Local Self-Reliance, where her research focuses on economic concentration and the health of local economies.

Grocery store chains still use 'old-school' spying to out-price competitors. The practice has piqued antitrust interests.

Kroger ads provide competitors price information, but
"spies" also visit stores in person.

When big grocery stores battle for market share, most chains deploy old-timey spies who sleuth prices, quality and customer behaviors. The "old-school tactics are fueling the government’s case against Kroger-Albertsons deal," reports Patrick Thomas of The Wall Street Journal. "Grocery-store operators scrutinize the websites and promotions of rivals and send managers to walk through competitors’ stores to help establish what shoppers will pay for items."

In the case of the proposed $20 billion merger between Kroger and Albertsons, how grocery stores compete matters. Government antitrust lawyers seek to block the merger because grocery companies "commonly use rivals’ prices as a benchmark in setting their own," Thomas explains. "Federal Trade Commission attorneys argued that Kroger won’t have the same incentive to lower prices in its stores without Albertsons. Price checks can provide a ceiling for what grocers charge shoppers."

While antitrust lawyers say competition between big grocery store chains helps keep prices down, attorneys for Kroger say merging with Albertsons will enable them to compete with Walmart. Thomas adds, "Kroger and Albertsons also said they price check against a number of different competitors in a given area, including Walmart, Target, and Amazon.com’s Whole Foods Market, not just each other."

Still, the active competition between grocers demonstrates how prices can be affected by grocery store sleuthing. James McCann, the former chief executive of grocery chain Ahold USA, told Thomas, "It’s about the perception of price in your store. If you are expensive, a lot of customers will migrate to other places." Thomas reports, "McCann said it is common to send an employee across the street to a competitor three times a week to check prices on about 30 items."

Even though Walmart is the world's largest retailer, it also uses old-school spying to gain market knowledge, and in turn, the company uses that on-the-ground information to squeeze cheaper prices out of suppliers. Thomas adds, "The retailer also has regional managers visit competitors and its buyers pressure suppliers to offer lower wholesale prices if managers find items sold cheaper elsewhere, people familiar with the process said."

Ultra-processed foods are unhealthy and may lead to chronic issues more common in rural populations

Ultra-processed foods are more accessible for many
rural residents. (Adobe Stock photo)

A common misconception about rural living is that residents have more access to farm-fresh food, but that idea is more of a myth. Rural residents often lack income and access to healthy, fresh food, which means their diets can evolve into a mishmash of cheaper and more ultra-processed food that may contribute to chronic health problems. Alice Callahan of The New York Times reports, "Scientists have found associations between UPFs and a range of health conditions, including heart disease, Type 2 diabetes, obesity, gastrointestinal diseases and depression, as well as earlier death." Many of these conditions are more common in rural populations.

While rural populations aren't alone in eating ultra-processed food, they do tend to be more obese than their urban counterparts, and UPFs can contribute to obesity, which can lead to Type 2 diabetes and other health issues. "UPFs can be easy to overeat — maybe because they contain hard-to-resist combinations of carbohydrates, sugars, fats and salt, are high-calorie and easy to chew," Callahan explains. "It's also possible that resulting blood sugar spikes may damage arteries or ramp up inflammation, or that certain food additives or chemicals may interfere with hormones, cause a 'leaky' intestine or disrupt the gut microbiome."

A direct link between obesity and UPFs hasn't been established, but researchers are exploring the relationship. Dr. Kevin Hall, a nutrition and metabolism researcher at the National Institutes of Health, told Callahan, "There are many 'strong opinions' about why ultra-processed foods are unhealthy. But there's actually not a lot of rigorous science on what those mechanisms are."

Some countries have "explicitly recommended avoiding or limiting UPFs or 'highly processed foods,'" Callahan reports. "The U.S. dietary guidelines contain no such advice, but an advisory committee is currently looking into the evidence on how UPFs may affect weight gain, which could influence the 2025 guidelines. . . . It's difficult to know what to do about UPFs in the United States, where so much food is already ultra-processed, and people with lower incomes can be especially dependent on them, Dr. Hall said."

Rural residents often have limited retail choices for groceries and staples; when dollar stores close, they have even less

In some small towns, dollar stores add grocery and staple options in remote areas with few or no alternatives. In other cases, dollar stores were built right next to the local grocery store, slowly chipping away profits and eventually closing the local business. In both scenarios, rural residents rely on dollar stores for affordable staples. When they close, rural people have fewer options.

"Even though inflation is cooling, prices are still higher than they were pre-pandemic. They've hit low-income consumers the hardest, which is why many shop at dollar stores," report Bianca Facchinei and Emily Grossberg of Scripps News. "Dollar stores aren't just about saving money; sometimes, they're the only option." Consumer Reports deputy editor Brian Vines told Scripps News, "So many smaller mom-and-pop and independent stores have had to shutter because of competition from dollar stores, and those very communities now are faced with the very real threat of having no retail."

Last week, Dollar Tree said, "It plans to close 600 underperforming Family Dollar locations between now and June," Facchinei and Grossberg add. "An additional 370 Family Dollar and 30 Dollar Tree stores will close at the end of each store's current lease term."

Vines hopes the closures may offer opportunities for new growth. Vines told Scripps: "We're thinking about independent grocery stores or other folks who can really provide robust offerings. They see fertile ground now that those value retailers who've undercut them in the past aren't operating in the space."

Monday quick hits: Old school buses now haul crops; outwitting food deserts; are farmhouses too pretty?

Old school buses help get melons from the farm to the
table. (Photo by Edwin Remsberg, Ambrook Research)

"While traveling on Interstate 95 in South Carolina, I noticed a strange sight. . . . A virtual parade of perhaps a half dozen old school buses was headed in the opposite direction. Well, they used to be old school buses. Now they were something different," reports Heath Racela of Ambrook Research. "It turns out that the small caravan of buses I happened to pass is a somewhat hidden lynchpin in the complex process of getting food — melons, specifically — from farm fields to tables. In fact, for watermelon farmers and harvesters, used school buses seem to be the dominant way to transport their delicate fruits out of the fields."

Gas. Electricity. Flintstones footwork. There are many ways to get vehicles going, but some truckers are getting behind hydrogen. The element is "gaining a following among some heavy-duty truck operators who see it as the industry's best path toward zero-emission technology, especially for rigs traveling long distances," reports Paul Berger of The Wall Street Journal. "Hydrogen offers longer trips and faster refueling than battery-cell technology, supporters say, while allowing trucks to haul heavier loads because they aren't carrying industrial-scale batteries."

Thank you American farmers.
(Photo by M. Sullivan Wirecutter)

While not singularly rural, festive cookies are loved by rural folks far and wide, and American farmers can brag that they helped make the cookies! In a nod to all the eggs, flour, sugar, and delightful dairy ingredients that flow from American farms during the holiday season, here's a list of all the loot that can help you make the best cookies.

The Mobile Farm Market gets fresh food to
grocery deserts. (ILSR photo)

Living in a food desert creates grocery challenges, especially for those lacking transportation. "When a new mobile grocery market launched in Wayne County, Pennsylvania, its first stop was Maple City Apartments, a 40-unit complex for low-income, elderly relatives. Maple City's residents have felt the region's lack of grocery stores acutely," reports Kennedy Smith for the Institute for Local Self-Reliance. "The county's residents can now buy groceries from a farmers market on wheels. It started when the Cooperage Project, a regional nonprofit organization, wanted to get fresh, healthy food to people during the pandemic. . . .Cooperage created Mobile Farm Market — a small, refrigerated van — to bring fresh produce, milk, cheese, and eggs to towns and neighborhoods lacking full-service grocery stores."

People with no desire to work the land are purchasing farms. (Photo by Zach McNair, AR)

Take a peek at Instagram, and "you'll be hard-pressed to escape romanticized images of farm life: rolling hills, broad wrap-around porches, oddly clean baby goats," reports Nora Neus for Ambrook Research. "The popularity of the farm aesthetic and farmhouse lifestyle is creating real estate problems among working farmers, especially younger and newer ones who already face challenges in finding affordable land across the country. . . . Farmhouse properties are so pretty, they're getting too expensive to use for agriculture."

How can the local supermarket be saved? This rural Kansas town of 1,000 has some tips for Chicago.

The Erie Market sets an example of how local grocers
 might survive. (Photo by Joe Barrett, The Wall Street Journal)

Facing lower profits and increased crime, many Chicago supermarkets are closing their doors. But some local governments are not giving up, and they've found a unique partner to help them learn how to open and run a municipally-owned grocery store -- the Erie Market in rural Erie, Kansas, pop. 1000, reports Joe Barrett of The Wall Street Journal.

"At the moment, things aren't going especially well. Erie Market, which the city took over in 2021, is losing money almost every month amid stiff competition from a Walmart 15 miles away and a Dollar General across the street. The store has slashed prices, cleared the shelves of expired items and put in a salad bar to try to bring more people through the door. But leaders aren't giving up." Erie City Council member Jason Thompson, a Republican who owns a trash-hauling business, told Barrett, "Without a grocery store, what are we going to do? It would kill this small town and it's hard enough to keep it alive as it is."

While Erie is one of few small towns to move to town-owned supermarkets, larger, more metro areas are also considering the idea. "Last month, Chicago, population 2.7 million, launched a study on the feasibility of opening a municipally-owned grocer to get more fresh foods and spur economic development in a number of mostly low-income neighborhoods," Barrett explains. "Chicago, which has lost six groceries on its South and West sides in the past two years alone, aims to take advantage of a new $20 million state fund designed to address what are known as food deserts across Illinois. Studies show that lack of access to fresh foods can have big impacts on health outcomes and rob neighborhoods and entire towns of economic vitality."

Having a municipally-owned grocery stores means an area can keep its local market even if it operates at a loss -- especially in the beginning. Ameya Pawar is a former Chicago City Council member and now a senior adviser at Economic Security Project, which will be working with the city on the economic feasibility study, including a planned trip to places like Erie to see how things work. Pawar told Barrett, "Communities and people in those communities deserve to survive and thrive. And, you know, that might mean accepting an operating loss for a grocery store."

Grocery stores have low margins, so earning a profit can be hard, but it can be done. "Less than 10 miles away [from Erie], the even smaller city of St. Paul, pop. 600, has run a successful city-owned grocery for about 16 years," Barrett reports. "Rick Giefer, who was mayor when the grocery store opened in 2007, said the town hadn't had a grocery store for 20 years and was facing the threat of losing its high school. City leaders thought a grocery would help keep the population in town. They reasoned that if they could sell water through a municipal entity, they could also sell food. . . . James Voorhies, who has run St. Paul Supermarket with his wife, Kelly, for about 10 years, says the business supports itself, including paying for new equipment. The city, he says, 'really doesn't have to do anything — they just oversee it.'"

Small town grocer co-ops and technology offer innovative answers for residents living in food deserts

CoBank map, from USDA Economic Research Service
Food Access Research Atlas data

 
 

It's more common for rural U.S. households to experience food insecurity, and while finding reliable access options has proved difficult, new business delivery options are offering solutions to hunger, reports Billy Roberts of CoBank. "Rural communities comprise 63% of all U.S counties but 87% of the counties with the highest food insecurity rates. . . . The Brookings Institution found delivery zones are concentrated in larger metropolitan areas, with only 37% of rural residents having access to any of the analyzed food delivery services."

While convenience and "dollar" stores have increased in rural towns, their ability to supply fresh food is still limited by population density. Additionally, when community revenue is compared between a dollar store and a local grocer, the local grocery store is a far better investment. Roberts reports, "CoBank and Food Co-op Initiative have worked together to expand programs for rural communities that have lost (or are at risk of losing) local grocery options. . . . An example is Marmaton Market in Moran, Kansas. A for-profit corporation operating under cooperative principles proved to be the solution for the town of 500. . . . The store emphasizes local as a means of supporting the economy, building morale and creating a stronger sense of community."

Beyond co-ops, current shipping and technology-based rural food delivery systems offer solutions. "Particularly for shelf-stable food and beverage, delivery mechanisms exist, even if it takes the form of FedEx, UPS or USPS. Fresh food offerings present another challenge altogether, but more direct-to-consumer approaches should, in the long term, be able to capitalize on improvements in technology (whether drone delivery or driverless trucks) to reach those who don't live near a grocery store," Roberts reports. "In collaboration with Gatik, Tyson Foods will deploy AI-assisted autonomous trucks to haul prepared meats over predetermined short-haul routes to distribution and storage facilities in northwest Arkansas."

As online options and technology improve, more delivery possibilities are created. "Whole Foods has made hundreds of its 365 private-label products available for U.S. shipping through Amazon," Roberts adds. "For its part, Walmart and Google subsidiary Wing are teaming up to test 30-minute drone delivery of household essentials and groceries to customers' homes within a six-mile radius of two stores in the Dallas-Fort Worth area. . . . These examples indicate where retailers — whether grocery stores or even convenience stores or dollar stores — could serve rural consumers and offset the issue of food insecurity stemming from limited access."

Is learning to garden a way to prevent food insecurity?

A youngster in Letcher County, Ky. enjoys the family garden.
(Photo by Silas Walker, Lexington Herald-Leader)

Many rural Kentuckians struggle with food insecurity, but teaching residents how to garden might be one answer to the problem, reports Rick Childress of the Lexington Herald-Leader. "Rising food prices and a sudden cut off of Covid-related federal benefits have made it harder for many in Eastern Kentucky and other rural areas of the state to access healthy, nutritious foods. While local pantries work to bridge the access gap by providing food, other nonprofits and researchers are trying to provide more ways for folks to grow or buy more of their own produce locally."

Gardening as a way of life predates the "region's decades of coal booms," Childress writes. "Jason Brashear, interim director of the Pine Mountain Settlement School said, 'Before coal, many people in the mountains survived and thrived on subsistence farming.'" Brashear told Childress: "If we go back in our history 75 years ago, everybody gardened. Everybody had some sort of a farmstead that they produced the majority of the food that they ate in the year." As coal jobs, money and local grocery stores entered the region, the popularity and knowledge of gardening dwindled.

Childress reports, "One program that has helped many 'return back to gardening' is Grow Appalachia, Brashear said. For over 13 years, the Berea College strategic initiative has partnered with nonprofits in multiple states to provide seeds and other gardening supplies needed to make an organic garden, as well as the education on how to grow and preserve that produce." Candace Mullins, the executive director of Grow Appalachia, told Childress: "Having the resources is a huge barrier to learning how to garden. It's expensive to buy hose, seeds, fertilizer, plants — I mean, you could easily spend $1,000 trying to get a garden going for a new gardener." Childress adds, "Since Grow Appalachia started, over 7,000 families have participated and harvested nearly 7 million pounds of produce, Mullins said."

"The Pine Mountain Settlement School has been a Grow Appalachia partner since 2010 and so far this growing season, they have 45 families involved in the program who have produced over 14,000 pounds of produce. Along with receiving supplies, they also participate in educational meetings at the school. Being able to access fresh food is perhaps just as big of an obstacle as affording it," Childress reports. 

Once food is grown and harvested, it has to be prepared, which takes learning. "A University of Kentucky research project, called Laurel HARVEST, aims to educate Laurel County residents on how to cook nutritious meals," Childress writes. "Kathryn Cardarelli, a UK faculty member in the College of Public Health leading the project, said the multi-year study offers a blend of in-person and Zoom sessions on topics like preparing food, eating healthy on a budget, and reading labels."

With smart planning and community spirit, some rural places succeed in keeping their local grocery stores open

Royal Super Mart allows families stay in town to shop.
(Royal Super Mart courtesy photo via The Post)

Rural grocery stores have been closing because of fewer residents, larger competitors and labor shortages. And that leaves residents with longer drives for staples and another community gathering space shuttered. Some states and rural towns, such as South Dakota and Sheffield, Illinois, have saved their local grocery stores with collaboration, creativity and resourcefulness.

North Dakota’s Commerce Committee and legislature began studying the closing of its rural grocery stores in 2019. Their research revealed that “North Dakota lost 15% of its rural grocery stores in towns with fewer than 2,100 people between 2013 and 2019, reports Laura Simmons of High Plains Reader. The losses were “driven by declining populations, distribution costs. . . online sales and dollar stores, according to North Dakota Grocers Association President John Dyste. 'North Dakota is losing rural grocery stores at an alarming rate, causing consumers to travel greater distances to access healthy food choices such as fresh meat and produce. This especially affects the elderly and low-income members of these communities; they are in many cases left with few choices to purchase healthy foods.'”

Strategies to help alleviate these problems included "collaborative purchasing and a spoke-hub distribution system," Simmons explains. "Rural Access Distribution Cooperative implemented these ideas in Walsh County. Three grocery stores in Park River, Hoople and Edinburg order together through separate accounts from the same supplier. This supplier then drops off all the food at Jim’s Supervalu in Park River. RAD then transports Edinburg's and Hoople’s food to the correct store. This format helps increase volume, which decreases price."

Bata told Simmons, “The community has supported us overwhelmingly. I think that this is showing in the numbers. . . . Hoople Grocery saw a 23% increase in sales and Edinburg’s Market on Main saw a 16% increase in sales."

In Sheffield, Illinois, Royal Super Mart owner John Winger wanted to sell his store and retire, but he couldn't find a buyer, reports Sydney Page of The Washington Post. "Apart from his store, Royal Super Mart, the nearest full-service grocery store is 15 miles away from the tiny town of Sheffield, Ill., a farming village with a population of about 800 people." When Royal Super Mart opened in 1940, it was one of four local groceries in town.

Winger felt like closing the store would be abandoning his neighbors, especially residents without transportation. Page reports, "Then last summer, Elizabeth Pratt, who grew up in a nearby town and has lived in Sheffield for 12 years, approached Winger with an idea. She offered to raise money through her nonprofit, a local wellness center called Cornerstone Community Wellness, to buy the store, with the goal of transforming it into a sustainable social enterprise, which is a business that reinvests its profits into its mission. This would ensure people would not have to leave Sheffield to buy fresh food."

"In a matter of months, the community raised $500,000, which was enough for Cornerstone Community Wellness to purchase the property and overhaul the store. Roughly 125 individuals donated, and contributions ranged from $5 to $50,000. About 15 percent of donations came from grants and corporations," Page writes. "Sheffield residents who donated were aware of the role local grocery stores play in both community and economic development in areas such as Sheffield. They also saw how the loss of independent supermarkets hurt other small towns."

When Safeway and Fry's started talking about merging, rural Arizona residents pushed back

In rural Arizona, resident are leery of grocery store mergers.
(Photo by Craig Smith, KGUN-ABC)

As Safeway and Fry's grocery store chains start discussing mergers, rural Arizona residents are concerned. "Rural opposition is coming together to a proposal to merge the Fry’s and Safeway grocery chains," reports Craig Smith of KGUN-ABC in Tuscon, Ariz. "The plan would have a nationwide impact because grocery brands in many states are part of the parent companies Kroger and Albertsons/Safeway."

Cochise County, pop. 125,500, over 6,219 sq. miles

(Wikipedia map)

Residents worry further corporate consolidation would inevitably close their neighborhood grocery store. "In a small town like Benson, you might only have a few places to go shopping for groceries. Skeptics about the merger say if it does close stores, people in Cochise County could have some long drives to get their groceries," Smith explains. Sierra Vista Mayor Clea McCaa "says with one Safeway and one Fry's, half of his city could become a food desert if the stores consolidate and one closes. He’s afraid of reduced competition, higher prices, and reduced access to other critical services like pharmacies."

The town of Douglas, which is also in Cochise Country, has already lost one grocery store. "Last year, Food City shut down. That left Douglas with a Walmart as its only large grocery," Smith adds. "Douglas Mayor Donald Huish says that costs people in his town time, trouble and money. Congressman Ruben Gallego is teaming up with rural mayors to send a letter to the Federal Trade Commission urging the FTC to reject the merger. Congressman Gallego says the merger could hurt small-town businesses too if customers drive out of town for their groceries and decide to do other shopping there too."

"Kroger is the company leading this merger effort," Smith reports. "Responding to the latest concerns, Kroger sent this: 'Kroger joining with Albertsons will mean lower prices and more choices for more customers in more communities, higher wages and more industry-leading benefits for associates, and growing union jobs. The only parties who would benefit if this merger is not completed are large, non-unionized competitors such as Walmart and Amazon.'”

A tale of two towns and dollar stores: One blocked Dollar General, one allowed it on 3-2 vote; local merchants worry

Leelanau County is the pinkie finger
of Michigan's mitt. (Wikipedia map)

What does a dollar store add to a small community, or perhaps take from it? That can be a loaded question.

In Leelanau County, Michigan, in 2019, residents got the zoning board to shut out Dollar General Corp.'s plans to build in the county seat of Empire  because the chain's reputation and look did not "fit" with their quaint, small-town vibe, and it's now the only Michigan county without a dollar store, reports Rose White of MLive, a Michigan newspaper chain. “Chain dollar stores tend to target food deserts like Empire . . . providing a limited selection of food to city neighborhoods or rural areas,” White writes, citing a report by the Institute for Local Self-Reliance.

Sperling's Best Places map

The dollar-store drama is playing out differently in Ebony, Virginia,  where some residents did not welcome Dollar General because they worried the store would "open the door to additional development that will spoil the character of their tiny, rural community of about 230 people," reports Michael Corkery of The New York Times. But not all the residents thought the chain would harm their town. "Jerry Jones grew up in Ebony. . . . He went on to manage grocery stores and later owned a gas station in Ebon. . . . Jones owns the land where the Dollar General would be built. He said the store would provide the county’s residents a convenient and affordable place to shop while also generating sorely needed tax revenue." Jones told Corkery: “You still need to have that balance between the people with nicer things and the people who live paycheck to paycheck. To me, Dollar General fits right in with that.”

The two places have some similarities; one big difference is that Empire is a summer tourist town where "quaint feel" has a financial impact. "Ebony sits on the edge of Lake Gaston and is a haven for second homes that serve as an important tax base" in Brunswick County, which has a median household income of $49,600, about the same as Leelanau's, but well under Virginia's statewide figure of $80,600, Cockery reports. "More than half the county’s population is Black." Only one-fourth of 1 percent of Leelanau County's is.

Brunswick County supervisors, by a 3-2 vote, "approved a zoning change that would allow the store to be built," Cockery reports. "The dispute in Ebony, which has been going on for more than three years, is about planning and zoning, but it also touches on a deeper issue simmering in many parts of rural America, whether the disputes are about cellphone towers or snowmobile trails. What does 'country' mean to different people in a small community?" Cockery asks.

But Dollar General is not winning everywhere. "The number of communities that are defeating specific dollar-store proposals or are enacting ordinances that control dollar store development is shooting up rapidly,” Kennedy Smith, a senior researcher at the Institute for Local Self-Reliance, told White. Much of the opposition comes from local business owners like Mohamed Abouemara, who "moved to southern Virginia from New York to operate convenience stores and has run the Ebony General Store for nine years," Corkery reports. "He said his store, where locals can socialize and buy hot food, played an important role in a rural community. A dollar store, he said, would significantly hurt his business."

Dollar stores take money out of towns and can deep-six other retailers; study suggests ways to mitigate their effects

A Dollar General store at Cunningham, Tenn., is one of a few with a mobile health clinic.

The ubiquitous growth of dollar stores can harm small towns' economies, writes Steve Dubb for Nonprofit Quarterly. "Dollar stores often function as economic kudzu, spreading relentlessly and cutting off the flow of dollars to homegrown businesses. It's not rare for dollar stores to swamp an entire community. . . . Chain stores take profits out of communities; local stores keep resources in communities. . . . Increasingly, dollar stores are driving 'grocery stores and other retailers out of business,' according to a recent report by the Institute for Local Self-Reliance."

Dubb provides a prime example: "In 2019, NP published a detailed study about the closure of a food co-op that had opened three years before in a Black community in Greensboro, N.C. From 1998 to 2016, that community lacked a full-service grocery store; the co-op's opening marked a triumphant moment after many years of community organizing. . . . So, why did the co-op effort fall short? As the study's authors, Marnie Thompson, Sohnie Black, and Ed Whitfield, detail, the community co-op failed in large measure because it came 'under direct pressure from more than 30 dollar stores within its two-mile radius.'"

To put the number of dollar stores into perspective, "There are more dollar stores nationwide than locations of McDonald's, Starbucks, Target, and Walmart combined," Dubb writes. The chains, which go by Dollar General, Dollar Tree and Family Dollar (the last two have common ownership), employ tactics that include locating in a lower-income area, near an already established local grocery and using "the Walmart business model where they squeeze suppliers by leveraging 'their power as major buyers to coerce suppliers into providing them with special package sizes and lower prices while charging independent grocers more and restricting the products available to them.' Mitchell, Smith, and Holmberg point out that this is illegal price discrimination—a violation of the Robinson-Patman Act of 1936, a New Deal-era antitrust law. Still, it is also very common given lax antitrust enforcement."

Despite the concept's numbers and tactics, there's a lot a community can do to prevent dollar stores from becoming their town's "kudzu." Dubb explains, "One common policy strategy is to mandate a minimum set distance between store locations. . . . Typically, laws restricting dollar stores are enacted in large cities, but rural communities also have mobilized. The ILSR report authors give a few examples of such rural campaigns, including one from Morgan, Minn., a town of 800 people, in which a petition drive of 100 people stopped a dollar store project, and one from Algansee, Mich., a small township near the Indiana state line with a population of 1,817. In that town, more than 200 residents—over 10 percent of the town's population—showed up at a local planning meeting to oppose a permit for a dollar store to be built across the street from the community's local grocery store; not surprisingly, the town commissioners voted down the dollar store's proposal."

But such cases are uncommon, and more can be done to change dollar stores' dominating effect, Dubb writes" "Mitchell, Smith, and Holmberg contend that local activists need help from state and federal policymakers. . . . reviving enforcement of the Robinson-Patman Act that limits price discrimination," Dubb notes. "A second priority, the authors contend, is to support local finance. . . . State governments can play an important role by reinforcing local planning agency authority to reject developments that are not in accord with community needs," and by "reinforcing local planning agency authority to reject developments that are not in accord with community needs. This can be done, for instance, by making dollar stores 'a conditional use that requires approval from the municipality (that is, it is a use that is never allowed "by right") and further clarifying that local governments may reject these stores on a wide range of grounds, including if they are likely to have a detrimental effect on the local economy or access to fresh food." In many states, localities can impose such restrictions without a change in state law. 

Small towns are creating and saving their local grocery stores; here's how a few are finding success

Prairie Market's design is inspired by a popular chain, Trader
Joe's Grocery. (Photo courtesy of Prairie Market)

You have no fried onions for tomorrow's green-bean casserole. You'll go to the store and get some if you're an urban dweller. If you're a rural dweller, you will have no fried onions unless you want to DRIVE. "The Department of Agriculture lists 76 counties nationwide that are without a single grocery store, and 34 of those counties are in the Midwest and Great Plains," reports Aaron Bonderson of Harvest Public Media. Rural grocery stores that do exist face stiff challenges. "Big-box stores and grocery consolidation have added even more pressure on local grocers. A recent USDA report shows the percentage of grocery sales from the nation's top 20 retailers more than doubled from 1990 to 2020, while the consolidation was more pronounced in rural areas."

Yet most small towns residents want a local grocery. Bonderson explains, "For about five years, Emerson, Nebraska, pop. 824, had no grocery, leaving residents to drive at least 20 miles for a full-service grocer. Then last year, the community came together to support a new co-op. . . . . Post 60 Market moved into the old American Legion building. . . . . Manager Brian Horak said the village of people invested nearly $160,000 in the store. . . . . Investors receive discounts, dividends and elect a board of directors each year to oversee large financial decisions." Horak told Bonderson, "With being a co-op and so many people bought in – it's like you got multiple owners who have just as much commitment to see this thing succeed."

Bonderson provides Circle C market in Cody, Nebraska, pop. 167, as an example: "It's run by the Cody-Kilgore school district. The store got started in 2008 with the help of several national organizations and a grant from the USDA. . . . . The Village of Cody owns the building, while the school district and a local nonprofit, Cowboy Grit, helped finance the store. . . . Each semester about eight students help at the Circle C Market as part of a class, learning important skills." Teacher and store manager Liz Ravenscroft told Boderson, "We are vital to the community. The next closest grocery store is 40 miles to the east, and the other closest grocery store is an hour to the west."

Other rural grocery stores have tweaked their business models to increase sales. "Laura and Don Palmer first started Prairie Market in Paullina, Iowa, pop. 952, eight years ago. Like many businesses, they struggled at first. Then they adjusted their hours, staying open on nights and weekends to cater to their customers, who often commute long distances," Bonderson reports. The couple painted their store a cheery shade of teal, mimicking a popular retailer. Laura Palmer told Bonderson, "My favorite store was Trader Joe's. . . . People come in the store, especially young people, they want to come in, and they want it to be vibrant and clean and organized."

Kansas is another state working to address the lack. It established "The Rural Grocery Initiative" to support rural grocery stores, reports Bonderson. The initiative's leader Rial Carver told Bonderson, "We've seen success with communities kind of becoming engaged through cooperatives, through public-private partnerships. We've even seen nonprofits and school run grocery stores, as well as municipally run stores in communities."

Dollar store mania: Six in and near a town of 1,400

Daily Mail map

A Dollar General store opened in Olive Hill, Kentucky, pop. 1,400, 50 years ago. Since then five more dollar stores have opened, all but one on the same road, U.S. 60, reports Keith Griffith for the Daily Mail. "In the Appalachian foothills, the town has two Family Dollar locations and four Dollar General stores. . . . leaving some residents wondering: Why so many dollar stores? Dollar General, like other major retailers, uses an algorithm to suggest new store locations. . . . Still, residents greet the recent explosion of dollar stores with a mixture of amusement and bewilderment."

"Just over the past couple years they’ve really started popping up," Jeremy Wells, editor of the Carter County Times, the local weekly, told Griffith. "People aren’t really upset by them, but they are a little puzzled." Griffith writes, "Over the past decade, dollar stores have been the fastest-growing food retailers by share of household expenditure, with growth in rural areas more than doubling, according to a recent study. . . . But critics noted health concerns about their food offerings, which skew toward high-calorie, ultra-processed packaged foods. . . . Dollar General has responded to this criticism by launching fresh produce sections in thousands of its stores, including several in Olive Hill." 

This Dollar General is also known as the ‘Olive Hill
Walmart.' (Photo by Keith Griffith, Daily Mail.com)

Christopher D. Merrett, director of the Illinois Institute for Rural Affairs at Western Illinois University, told Griffith that in some cases, a new dollar store can be a boon to rural areas where local businesses have shuttered; however, "If you are a small town that does have an existing grocery store, it's more complicated. It's not unilaterally positive. . . . We don’t want it to be a zero sum game, where a new store takes business from a longstanding locally owned business. It could force that existing grocery store to close."

Griffith notes, "Dollar General has expanded aggressively in rural areas and small towns, typically seeking out areas that are at least 20 miles from the nearest Walmart or major grocery chain. . . . its biggest footprint is in Southern states, and roughly 75% of Dollar General stores are in towns with populations under 20,000. . . . ‘We serve millions of Americans who may not have affordable food options nearby,’ Dollar General said in a statement."

The first Dollar General in the county was a "totally different experience," Wells said, with "a limited selection of mostly low-end dry goods," Griffith writes. "Olive Hill residents jokingly refer to the Dollar General closest to downtown as the ‘Olive Hill Walmart’ due to its wide variety of goods, including a small produce section stocked with fruits and vegetables." The town also has a Sav-A-Lot discount grocery. It is the birthplace of the late Tom T. Hall, country songwriter.

'East Kentucky Flood' tells the story of a deadly disaster, a courageous and heartfelt recovery, and an uncertain future

Rockhouse Creek, a major tributary of the North Fork of the Kentucky River, flooded Isom and its supermarket.

The record flash floods in southeastern Kentucky last summer killed 45 people and worsened a regional housing shortage. More than six months later, hundreds of people are still staying in campers or substandard housing, Bill Estep of the Lexington Herald-Leader reports. Some people in the region worry that it will become depopulated, but others see the flood as an opportunity to build back better. They're the stars of a half-hour documentary, "East Kentucky Flood," produced by the Center for Rural Strategies in Whitesburg, one of the flooded towns.

Letcher County, Kentucky (Wikipedia)

Like all well-told stories, this one is in three parts: Stories of the flood and its close calls, the courageous and heartfelt response, and the ongoing recovery and prospects for the future. And it focuses on one Appalachian county, Letcher, which has the headwaters of three rivers. The villain in this story, funded by the Flora Family Foundation, is the North Fork of the Kentucky River.

A man recalls the waters rising around him: “It was everything I could do to keep my feet on the ground.” Another tells of a woman in her late 70s who uses a walker but hung on to the roof of her front porch for five hours awaiting rescue. Whitesburg firefighter Charles “Red” Colwell found a woman neck-deep in water and couldn’t get her into a kayak: “I just found some adrenalin and I just was able to put her in that kayak. I said, ‘We have to go. We have to go now. I cannot swim.’”

Much help came from “the hillbilly refugees, the people who have moved out of here,” recalled Gwen Johnson of the Hemphill Community Center. “They knew we weren’t gonna get any help from anybody else,” and started making contact. “When the roads opened up, they rolled in here.” She said three “drunk angels” arrived with a load of meat and “stayed with us three days, and I don’t think they drew a sober breath while they was here, and they just kept on a-cookin’.” 

But much help has also come from local residents, including fellow victims. Huffman said, “I noticed that the ones who lost so much have been trying to help everybody else.”

Appalshop filmmaker Willa Johnson recalled, “I didn’t know the people who were showing up to help me – or it was people I never expected show up to help me. People who have very openly disagreed with me on politics – it’s become a line in the sand for us, and we just can’t talk – were showing up.”

Photographer Malcolm Wilson of Blackey said he made 2,500 images of the flood, “some of the hardest photographs I’ve ever made in my life. . . . Some things I didn’t photograph, that I saw; I just couldn’t bring myself to do it . . .  The other thing that really blew me away was the Isom IGA.”

Simon and Gwen Christion in their Isom IGA, being rebuilt (Images from documentary)

The rural supermarket's owner, 67-year-old Gwen Christon, who had spent 50 years in it, told the filmmakers, “For a week, I actually walked around in shock, wondering what I was going to do.” But her tragic story brought outside help, and a determination to reopen, with the help of her son, Simon, who decided two years ago to follow in her footsteps. She said she worked 50 years to buy the store and pay the mortgage, and he said “I’m next in line to work another 50 years and get it paid up.” She said, “We plan on opening April 1, 2023. This is our home. This is our people, and we have to stick together. . . . I think we can come back stronger. I think we can come back more together.”

Angie Hatton hopes that's true. The former state representative, defeated for re-election due to gerrymandering fostered by long-term population loss, said tearfully, “I just don’t want people to move away. The people who’ve stayed have been so brave to try and stay, you know . . . We can do a lot with a little here; we always have been able to. And for those who are moving away, I get it, you know, I understand, but I just hope we can find a way to build housing up off of the creeks, flood-proof our bridges and use this disaster was, instead of the end of us, as a catalyst for a new beginning for everything that makes it hard to live in Eastern Kentucky.”

Coal companies own most of the high ground. Educator Jeff Hawkins mentions coal without saying the word: “Part of the struggle has been that we have been so closely connected to a single industry; it has really driven our economic base and our personality and who we are for a century.”

Wes Addington of Appalachian Citizens Law Center said as he was surrounded by relatives’ homes: “It’s really difficult to figure out, well, how do you move away, or how do you leave the place? And I haven’t mentioned, it’s like, a beautiful part of the country. It’s a really pretty place to live.”

But how does it build back better? “Frankly, it's gonna require a lot of federal money – and interest in, you know, supporting a region that’s really supported a lot of the rest of the country’s growth over the past 100 years," Addington said. "That’s what I hope happens. I think it’s really uncertain.”

WEKU-FM has concluded its six-part series "Rise" about the flood and recovery. The opening narrative for the closing episode: "While still adjusting to such heavy loss and amid much uncertainty, Eastern Kentuckians are giving careful consideration to the future. In addition to addressing the immediate need for housing on higher ground, that future includes preparing for the possibility of more frequent extreme weather. Is this a turning point? Or just another turn on the curvy road ahead? Residents demonstrate the most important key to a strong community is knowing how to show up for your neighbors."

Inflation rates omit rural Americans, whom it may hurt more

Data from Bureau of Labor Statistics; chart by The Conversation (click it to enlarge)

This may surprise you: When the Federal Reserve Board meets this week to consider raising interest rates again to fight inflation, rural inflation will not be included in its analysis. "The main indicator of inflation, the Consumer Price Index, is compiled by looking at the changes in price specifically urban Americans pay for a set basket of goods. Those living in rural America are not surveyed," economists Stephan Weiler and Tessa Conroy report for The Conversation, a platform for journalistic writing by academics.

"We believe this poses a problem," Weiler and Conroy write. "People living outside America’s cities represent 14% of the U.S. population, or around 46 million people. They are likely to face different financial pressures and have different consumption habits than urbanites. . . . it may even be masking a rural-urban inflation gap." Weiler and Conroy did their own rural-urban inflation gap research, which outlined some distinctive differences:

Vehicle expenses: "Car ownership is integral to rural life, essential for getting from place to place . . .  Urban residents can more easily choose cheaper options like public transit, walking or bicycling. This has several implications for expenses in rural areas. . . . Longer journeys mean cars and trucks will wear out more quickly. As a result, rural residents have to devote more money to repairing and replacing cars and trucks. . . . Periods of high energy prices, such as the one the U.S. experienced through much of 2022, are likely to disproportionately affect rural residents given the necessity and greater distances of driving."

Food security: "Rural residents already spend a larger amount on eating at home, likely due in part to the slimmer choices available for eating out. This means they have less flexibility as food costs rise, particularly when it comes to essential grocery items for home preparation. And with the annual inflation of the price of groceries outpacing the cost eating out – 11.8% versus 8.3% – dining at home becomes comparably more expensive. . . . Rural Americans also do more driving to get groceries; the     median rural household travels 3.11 miles to go to the nearest grocery store, compared with 0.69 miles for city dwellers."

Health care: Rural residents trend older, "and older people spend more on health insurance and medical services. Medical services overall have been rising in cost too, so those older populations will be spending more for vital doctors visits. . . . On average, rural Americans travel 5 more miles to get to the nearest hospital than those living in cities. And specialists may be hundreds of miles away."

Home energy costs: "Poorer-quality housing leaves rural homeowners and renters vulnerable to rising heating and cooling costs, as well as additional maintenance costs."

Weiler and Conroy note, "While there is no conclusive official quantitative data that shows an urban-rural inflation gap, a review of rural life and consumption habits suggests that rural Americans suffer more as the cost of living goes up. . . . rural inflation may be more pernicious than urban inflation, with price increases likely lingering longer than in cities."

Consolidation of groceries has greater impact in rural areas but some small-town markets find ways to survive

Cover of Economic Research Service report

The consolidation of groceries is greater in rural areas, according to a new study from the Economic Research Service of the U.S. Department of Agriculture.

“Food retailing markets in rural and small non-metro counties are considerably more concentrated than food retailing markets in metro and large non-metro counties,” the report says.

"That means for many small town residents, buying food requires driving to Walmart a few towns over or trying to make do with prepackaged and canned foods available at a Dollar General," reports Jonathan Ahl of Harvest Public Media.

The report "shows the percentage of grocery sales from the nation’s top 20 retailers more than doubled from 1990 to 2020," Ahl notes. "Even as small, full-service grocery stores become less common, some small-town grocers are finding ways to stay competitive, while in other communities, they’re banding together to start their own."

Ahl cites Sanborn Foods in Sanborn, Iowa, a a town of 1,400. Owner Scott Vogelaar "joined the Associated Wholesale Grocers, a co-op of small stories based in Kansas City. . . . He also works to differentiate his store through quality and service in particular departments," meat and produce.

"When the supermarket closed in Mount Pulaski, Illinois, a community-owned grocery store took its place," Ahl reports. "In 2020, Market On The Hill opened in the town of 1,500 people. The store focuses on locally grown and made foods to help differentiate themselves from national chains several miles away, as well as the dollar store that opened in town."