'Great Wealth Transfer' is coming, and some funders are working to plant philanthropy money in rural communities

Graph by Sarah Melotte, The Daily Yonder,
from Federal Reserve data

Over the next two decades, tremendous amounts of American wealth will transfer from generation to generation. "In the next 20 years, about $84 trillion will change hands. . . . Economists call it the Great Wealth Transfer," reports Sarah Melotte of The Daily Yonder. "Small-town philanthropies hope to capture some of that wealth for the benefit of historically underfunded rural communities. . . . Some experts worry the transfer might reinforce economic inequality [but] rural philanthropists are thinking about how people might invest this money to create healthier communities."

Ben Winchester, a rural sociologist with the University of Minnesota Extension, told Melotte, “You can get your cup under this wealth that potentially is going to be transferred, and pour it back into your town and bring that wealth here." 

As part of his research, Winchester recently released a report on the Great Wealth Transfer in rural Minnesota. "The report found that in the coming decade, $5.6 billion will change hands across 10 central Minnesota counties," Melotte explains. "If local foundations could capture even one percent of that transfer, it could funnel $56 million into local infrastructure."

Philanthropic work can build additional supports across a wide range of needs within rural communities that have "often been left out of larger sources of both private and public funding," Melotte writes. “Many rural economies also suffer from long-term lack of investment. As a result, residents of nonmetropolitan counties are more likely to live in communities with persistent poverty."

Executive Director Erin Borla of the Roundhouse Foundation, a rural philanthropy in Oregon, asked Melotte, "If you’re from a farming community, or a logging family or whatever the rural livelihood was, does the next generation [who controls that wealth] live in that same community?” Melotte adds, "Borla said that the local wealth that is generated in a rural community can end up redirected to other economies throughout the country as people move away. Small-town foundations are aware of this trend, according to Borla, which is why they’re focused on directing those funds back into local projects."

Rural Minnesota is receiving wealth-transfer guidance from one of its foundations, CommunityGiving. Steve Joul, president of CommunityGiving, advises rural communities to envision what a healthier future for their town might look like. Joul told Melotte, "You need to have all the players at the table. It’s an open invitation to the community to come to the table to craft an idea and vision for where you want to go.”

According to Joul, everyone means everyone. Melotte adds, "Joul emphasized the importance of avoiding the common trap of only including residents with power and resources. Engaging more stakeholders helps mitigate worsening wealth inequality."

In Montana, the cost of living and lack of affordable housing and child care contribute to growing workforce shortages

Rural Montana is a 'canary in the coal mine' for severe 
 labor shortages in needed sectors. (N. Fouriezos photo)

Across the country, the need for a younger workforce to fill a wide range of positions is reaching a critical point, but particularly for rural areas. Students and potential workers face a range of obstacles that prevent them from filing those roles, reports Nick Fouriezos of The Daily Yonder. In Montana, medical, academic and labor professionals are working to address these issues.

Lindsey Flather from Bitterroot Valley, Montana, is the kind of student Montana's new strategies aim to help. Fouriezos writes, "A working mother in her thirties, Flather decided to pursue a new career in health care. . . . And she is urgently needed. In Montana, 52 of 56 counties — including Ravalli County — are considered medically underserved, and nearly half of the state’s nurses say they plan on retiring or leaving the profession in the next five years."

Like many of her fellow students, Flather has faced long commutes for classes, a lack of child care options, and juggling to make work and school mend together. "At the same time, employers are desperate to get more people through these workforce pipelines," Fouriezos explains. "They, too, are challenged by geography, says Rebecca Conroy, the chief transformational officer at Bitterroot Health, a regional hospital in western Montana."

Yet even when needed professionals, such as medical assistants, graduate they often can't afford to live in the county where they are needed most. "The median rent in Hamilton, Bitterroot Valley's biggest town, is now $2,087, up 30% over the previous year," Fouriezos reports. "The lack of affordable housing makes it almost impossible to recruit out-of-towners, and the in-town workforce is drying up. The talent pipeline is thin, Conroy says. And the pressure is only growing."

"Employers like Conroy are the canaries in the coal mine of a growing talent shortage nationwide. So smoothing the route to jobs like medical assisting has become a key focus of Montana’s government and educational infrastructure," Fouriezos writes. "The state’s colleges recently partnered with the national nonprofit Education Design Lab to interview Conroy and local business leaders statewide about how they might create new educational opportunities, like a set of micro-credentials to allow people to build key skills in shorter courses over time."

Many retirees are moving to southern Appalachia, and local governments are struggling to cope with their needs

The Appalachian Mountains in Georgia.
(Photo by Jairph, Unsplash)

Once known for its rustic beauty, moonshine stills and impoverished residents, southern Appalachia's population is expanding as baby boomers from around the country relocate from more expensive regions. "The boomer migration to North Georgia, East Tennessee, the Carolinas and western Virginia is reshaping housing prices, traffic patterns, restaurant options and how local governments cope with something they haven't had to handle before: explosive growth," reports Cameron McWhirter of The Wall Street Journal. "Each year since 2020, an average of 328,000 people from other parts of the U.S. moved to the five-state region, according to Hamilton Lombard, a demographer at the University of Virginia.

Dawson County, Georgia, is the region's leader in population growth, which "saw a 12.5% increase from 2020 to 2022, reaching just over 30,000, according to estimates by the Census Bureau. . . . In Dawson, the population aged 65 or older reached 21% of the county in 2022, up from 14.1% in 2010. Many moving to the region are wealthier," McWhirter writes. "Dawson's home prices rose 46% compared with 39% nationally, according to Lombard's analysis of Zillow housing prices. Other Appalachian areas like Dawson saw similar spikes, the analysis showed."

In Dawson County, not everyone agrees on how to manage regional growing pains. McWhirter reports, "When Billy Thurmond was a boy, most roads here were made of dirt. Now 64, Thurmond, chairman of the Dawson County Board of Commissioners, said he is regularly stopped at the local Walmart and asked about development and traffic issues. There's a twist: Many of those complaining are people who moved to the county in recent years."

Northern Georgia isn't alone in facing conflicts stemming from exponential growth. McWhirter explains, "From April 2020 to July 2022, the population in counties in southern Appalachia designated retirement or recreational areas grew by 3.8% — more than six times the national average, according to Lombard." Expanding towns face constant change as their governments, medical and emergency services, and recreational and retail offerings work to accommodate newcomers. "The influx of wealthier, older Americans has created challenges for governments working to expand services, including broadband, water and wastewater services, roads, health services and housing."

To explore the southern Appalachian population growth graphed by the numbers or to learn why these baby boomers are known as "halfbacks," click here.

Expectant moms face OB-GYN deserts; one state is an example of the national problem

A mother holds a newborn baby.
(Photo by Katie Klingsporn, WyoFile)

Wyoming is one of many states where women and families are finding obstetric care harder to find. "More than 15% of Wyoming women had no birthing hospital within 30 minutes of home in 2022, compared to 9.7% of women nationally, a report by the March of Dimes shows," Katie Klingsporn of WyoFile reports. "Such distance from care comes with real risks. Women who live farther from delivery hospitals are more likely to experience adverse medical outcomes. . . . In rural areas of Wyoming, 22.4% of women live over 30 minutes from a birthing hospital compared to 5.2% of women living in urban areas, according to the March of Dimes."

Nestled in west central Wyoming, Fremont County is "not unique, but with one obstetric practice, one midwife and one birthing hospital serving the general population of Fremont County — a New Hampshire-sized area that's home to nearly 40,000 people — the situation here offers a window into the challenges, and consequences, of limited maternal health services," Klingsporn writes. And while Fremont County has a 24/7 delivery center in SageWest Hospital in Lander, women who labor and deliver there will most likely be treated by a traveling doctor, who is also a stranger. 

Map of towns Fremont County women travel to for
obstetric care. (Map by Eda Uzunlar,WyoFile)

Traveling in Wyoming can be both risky and expensive. It "requires money, childcare, work flexibility and other resources that not everyone has. And then there's the issue of winter travel in Wyoming, where icy storms regularly close roads and ground air ambulances," Klingsporn reports. "The OB shortage is not isolated to Fremont County. Hospitals in Rawlins and Kemmerer stopped offering delivery services in recent years. Other counties like Sublette and Weston don't have birthing facilities at all."

Jen Davis, Gov. Mark Gordon's senior policy advisor on health and human services, "said of the dearth of maternal health care, 'It's a huge problem,'" Klingsporn writes. 

While traveling longer distances to see obstetric providers can lead to poor outcomes, more pregnant women in Wyoming are having to take that risk. "The farther a woman travels for maternity care, the greater the risk of maternal morbidity and adverse infant outcomes," Klingsporn reports. 

The loss of labor and delivery care is a national problem. "In 2022, the March of Dimes reported on the problem of 'maternity care deserts' across the United States," reports Stacey Kelleher for Health eCareers. "These communities do not have birthing centers or hospitals offering obstetric care. Outside these maternity care deserts, which affect more than two million women of childbearing age, nearly seven million other women and 500,000 births are also impacted by low or no access to Ob-Gyn care in this country."

Too few volunteer firefighters is an acute crisis in rural places; The 'antiquated model' must change

Fire crews are a rural area's 'first line of defense' for most
emergencies. (Photo by Peter Crabtree, The Daily Yonder)

Rural fire departments have struggled to get adequate funding, volunteers, and employees, and the problem is getting worse. "A slow but steady decline in volunteers is catching up with America's small-town and rural fire departments," reports Caitlin Randall of The Daily Yonder. "Some solutions – like better funding, a different volunteer structure, and more publicity – aren't simple. And others – like the need for more jobs to retain young people – are beyond fire departments' control."

Wikipedia map

Randall's report focuses on a small fire department in Bennington, Vermont, pop. 15,400, working to put out a fast-burning brush fire "in one of the most remote corners of southern Vermont. By the time the first crew arrived, the fire had spread with shifting winds coaxing a rapid uphill burn. . . . With just seven volunteer firefighters available to tackle a wildfire that might torch hundreds of acres of mountain wilderness, a mutual aid request went out to four other departments, including one from across the state line in New York.

"Other crews responded, but they, too, were dealing with a depleted volunteer corps. As each new team scrambled up the rugged terrain, others stepped back, exhausted from time spent digging fire lines — dirt channels in the angled terrain — and tackling burning brush while carrying power tools and 40-pound water packs. It was grueling, dangerous work with little rest while the blaze burned on, in this case, for nearly eight hours."

The lack of volunteer firefighters is a nationwide problem, more acutely felt by rural areas, such as Vermont, where "88% of their fire crews are staffed mostly or entirely by volunteers," Randall explains. "Fewer and fewer people are joining their ranks, and long-time volunteers are aging out. The crisis isn't confined to Vermont. Nationally, 70% of fire departments are mostly or entirely volunteer, and the number of new recruits is also declining."

The National Fire Protection Association, which tracks the numbers of volunteer firefighters in the United States, says the numbers have dropped 17% over a five-year period, Randall reports -- "from about 815,000 in 2015 to 677,000 in 2020, the last year for which figures were available. It's in small towns and rural areas with fewer resources where the falloff in volunteering has been felt the most, in communities where firefighters are the first line of defense for everything from fires to car crashes to natural disaster rescue missions."

"Among the raft of recruitment and retention challenges facing volunteer fire departments, stringent training and certification guidelines top the list," Randall explains. Rural fire departments bear the added burden of needing more good-paying jobs to keep volunteer firefighters in town. 

Rabbi Howard Cohen, who served as fire department deputy chief in Bennington, told Randall, "We have huge respect for firefighters, but we need to acknowledge the fire service has been in a state of crisis for a long time. It’s an antiquated model that absolutely needs to change."

Rural doctors have to do it all, from snake bites to meat-stuck-in-throat; video looks at challenges of rural medicine

Amid a national physician shortage, getting a doctor to practice in a rural place has never been more challenging, and as rural hospitals close, the lack of providers is predicted to worsen, reports Hyacinth Empinado of STAT. "In 2023, 65% of rural areas had a shortage of primary care physicians, according to a report published by the Health Resources and Services Administration. More than 15% of Americans — about 46 million — live in rural areas, but only 10% of doctors practice in these communities, many of whom are primary care and family physicians."

Meeting the medical needs of 46 million Americans is a big undertaking. And because there are so few doctors, each has to work harder to tackle vastly different medical illnesses and accidents with limited resources. In this short documentary, STAT explores why the shortage exists and "shows what life is like for a doctor in Kansas who wears many hats and a physician in Illinois pondering retirement."

Rates of depression in Appalachia are startling; persistent stigma keeps residents from asking for help

Logan, West Virginia, is the largest town in Logan County.
(Photo by Phil Galewitz, KFF Health News)

Depression is a painful mental health disease that can prevent people from participating in daily life. However, admitting to mental depression is still stigmatized even in places like West Virginia and its surrounding Appalachian states where the disease is most concentrated; asking for help is one of the biggest problems, Phil Galewitz of KFF Health News reports. “An estimated 32% of adults in Logan County, W.Va., have been diagnosed with depression — the highest rate in the United States and nearly double the national rate, according to a report released in June by the Centers for Disease Control and Prevention.”

Logan County, W.Va. (Wikipedia)

The study, which provided estimates by county based on a national survey of nearly 400,000 people conducted in 2020, “showed depression rates varied widely by region and even within states,” Galewitz writes. Almost all the counties with the highest rates were Appalachia. . . . “West Virginia, which also has some of the nation’s highest rates of poverty and poor health, is home to eight of the 10 counties with the highest estimated rates of adult depression, the CDC survey found.”

Depression is an insidious disease. “It’s a mood disorder that causes a persistent feeling of sadness and a loss of interest in things once enjoyed. It affects eating, sleeping, concentrating, and activities such as working or going to school.” Mark Miller, a psychiatry professor at West Virginia University, told Galewitz, “Depression is often a chronic illness, and if you stop treatment, it eventually comes back.” Galewitz adds, “He said his state’s combination of poor overall health, low education levels, and poverty — as well as the opioid epidemic, which has hit West Virginia particularly hard — takes a punishing toll on residents’ mental health.”

“In Logan County, nearly a quarter of whose 31,000 residents live in poverty, few expressed surprise when told their home tops the list of most depressed counties,” Galewitz adds. And yet, medical professionals in Logan County are not busy giving mental health referrals or treatment. “Robert Perez, an internist in Logan, estimates more than half of his patients have depression. But he said few want to talk about it or accept a referral to a psychiatrist, and he is limited in what he can do for them.” Perez told Galewitz, “It’s hard to convince people who don’t want to be helped. I don’t have that much time to treat their depression.”

People can also harbor beliefs that asking for help means they’re lacking faith in God or that persistent unhappiness can result from cloudy weather. Galewitz writes, “Indeed, Chris Palmer, an assistant professor of psychiatry at Harvard Medical School, said the notion that cloudy weather explains high depression rates does not help the problem. That viewpoint ‘strikes me as a hopeless and nihilistic attitude, that we are drowning and there is nothing we can do about it,’ he said.”

“In June, the same month the CDC released its findings, Coalfield Health Center, a federally funded clinic in the county, announced it had hired its first psychiatrist, David Lewis,” Galewitz reports. “Lewis, who grew up in Logan County and taught high school math here, said he has seen about 50 patients so far and knows he has room to see more. . . . Coalfield is struggling to overcome the stigma and other treatment obstacles around depression.”