Opinion: The Rural Health Transformation Program challenges states to build and overhaul systems

R.J. Marse

When the Centers for Medicare & Medicaid Services announced $50 billion in funding for the Rural Health Transformation Program, many Americans may have assumed the money would help struggling rural hospitals shore up their finances and stay open. 

But RHTP program dollars aren't meant to prop up declining systems by helping them maintain the status quo of rural health care, writes R.J. Marse, General Counsel at Sprinter Health, in his opinion for Healthcare IT Today. "At $50 billion over five years. . . the amount is significant, but more noteworthy is the program’s intent."

The program aims to change how rural health care is approached and practiced by incentivizing innovation, technology and successful outcomes across a system.

RHTP challenges rural health systems to go beyond traditional health care infrastructure by designing and launching treatment that includes "telehealth and remote monitoring. . . technology-enabled solutions that allow providers to practice at the top of their license," Marse writes. "It even allows states to invest in early-stage healthcare companies, a signal that the ultimate goal is innovation."

Marse explains, "Funding is conditioned on outcomes, so while the aim is to reach more rural patients in more rural communities, interventions will need to do so in ways that measurably improve health and lower long-term costs."

RHTP structural demands push rural health care systems to combine modern medical treatment models with the inherent challenges of working with a rural population. Marse writes, "RHTP demands confronting the fact that many rural patients will not engage with care unless it comes to them – or, at least, closer to them. . . . Rural care transformation must, by necessity, be hybrid. It should deliver care virtually when appropriate, and physically when and where it’s needed."

"Rural health doesn’t need another bailout. It needs fundamentally different operating models that can endure when federal dollars dissipate," Marse explains. "Five years from now, RHTP will be judged not by how much money was spent, but by what was built." 

New $100,000 visa fee leaves rural schools with few options to fill in-person teaching positions

Many rural schools have depended on foreign teachers
to fill teaching positions. (Photo by K. Eliason, Unsplash)

At a time when rural schools can least afford to lose teachers, some school administrators have stopped offering international teacher contracts or contract renewals due to higher visa costs and uncertain immigration policies, reports Michael Melia of The Associated Press.

Teachers are in short supply across the U.S., with the shortage most acutely felt in rural counties that can't offer higher salaries or city amenities to recruit new educators. To fill the gaps, rural schools turned to international teachers. Melia writes, "More than 2,300 people with H-1B visas work as educators across 500 school districts."

Superintendent Vallerie Cave, who oversees schools in rural Allendale County, S.C., has consistently employed foreign teachers to fill roughly 25% of her open teaching positions, Melia reports. But this year, Cave is ending contracts and not extending new offers. She told AP, "Some of my very best teachers are having to return to their countries."

Early in 2025, the Trump administration raised H-1B visa fees to $100,000, which allowed "highly skilled foreign workers to be employed in the U.S," Melia explains. "The Trump administration argued American employees were being replaced, particularly in highly paid roles at tech companies."

In rural counties like Allendale, where poverty is high and teacher salaries are low, paying higher visa fees isn't feasible. And while many rural administrators will try to hire locally to fill gaps left by international teachers, many will add more online teaching or "consider hiring uncertified instructors, combining classes or dropping course offerings."

Some international teachers could teach in American schools with a J-1 visa, which "is not subject to the new fee," Melia adds. But many international teachers have decided not to teach in the U.S. for now and have chosen to go home. In turn, many American rural school districts are avoiding any visa issues by eliminating international teacher hires.

Like many rural school superintendents, Cave says she will do all she can to fill teaching gaps with certified teachers, but admits it will be hard. She told the AP, "I can’t really do competitive pay. For rural America, impoverished America, it is still a problem recruiting teachers.”

Brown tap water and an ongoing boil order highlights water systems under stress in rural towns

Brown water from a Tallulah residential tap.
(Photo by Donald Wood via WWNO)

In Tallulah, Louisiana and Cotton Plant, Arkansas, there's plenty of drinking water, but it runs brown from residential faucets and leaves stains on most things it touches.

Both small towns have sunk into debt paying for repairs to their aging water infrastructure. Despite those efforts, most Tallulah and Cotton Plant residents still face brown water in their taps, report Elise Plunk, Lucas Dufalla and Phillip Powell for New Orleans Public Radio, WWNO.

The water problems in both towns aren't isolated issues. Of the more than 45,000 community water systems that serve 10,000 people or less, "more than a third fell out of compliance with federal water standards sometime in the 12-month period that ended last September," WWNO reports. "For many of the 66 million Americans who live in rural places, [those systems] are the main source of water."

Tallulah used to be a vibrant town, but over time, its population dwindled, shrinking municipal tax revenue needed to repair aging water systems. Tallulah owned its water system and used its income to cover the rest of the town's needs, rather than investing in water system upgrades and repairs.

Some Tallulah residents purchased expensive filtering equipment, but even that hasn't been a full solution because the poor water quality breaks the filters.

Cotton Plant, Arkansas, residents have been dealing with "a boil order since last year, with little hope of securing the funds needed to fix an aging water system that is drowning in debt," Plunk writes. "The town’s water struggles started in 2023 and worsened in 2025, after a break in one of the main water lines sent discolored water rushing through residents’ taps."

Cotton Plant was a bustling agricultural town with 1,800 residents at its peak in 1950. According to WWNO, the town's water system is now too large and too expensive to be maintained by Cotton Plant's ever-shrinking population, which hovers at 530 people. Without tax revenue to address water system needs, the town borrowed money from the Arkansas Department of Agriculture and the USDA. Cotton Plant's water is still undrinkable.

This story was produced by the Mississippi River Basin Ag & Water Desk, an independent reporting network based at the University of Missouri, in partnership with Report for America.

Tribal lands need broadband to improve health care access, but progress is slow

Shoshone-Bannock tribal lands are vast with a rocky terrain, which poses a challenge in building fiber-optic cable lines for high-speed internet to homes. (Photo by Sarah Jane Tribble, KFF Health News)

The lands of the Shoshone-Bannock Tribes in Idaho span seemingly endless miles. But the beauty of this vast tribal expanse comes with a cost: Profound broadband gaps that limit health care for Native Americans throughout the region. "Tribal members are historically underserved and, on average, live with the highest rates of chronic illnesses and die 6.5 years earlier than the average U.S. resident," reports Sarah Jane Tribble of KFF Health News.

Accessing medical treatment without broadband connectivity presents a range of challenges. Tribal members have to drive to medical appointments because telehealth isn't an option. "Tribal field nurses update charts in paper notebooks at patients’ homes, then drive back to the clinic to pull up records, send orders, or check prescriptions," Tribble writes. Getting care and medicine all takes longer.

All the while, millions in federal dollars have been set aside to address tribal broadband infrastructure. "Three years ago, the Shoshone-Bannock Tribes were awarded more than $22 million during the first round of the federal Tribal Broadband Connectivity Program," Tribble explains. "But tribes that were awarded millions in a second round of funding saw their payments held up under the Trump administration."

Shoshone-Bannock Tribes Broadband Infrastructure Deployment project
(Map by Lydia Zuraw and Sarah Jane Tribble, KFF Health News)

For some tribal members, waiting for fiber isn't an option. Instead, they pay for Starlink, which uses low-earth-orbit satellites and costs between $80 and $120 a month. "For 53-year-old Carol Cervantes Osborne, who lives with constant pain from severe rheumatoid arthritis, having internet is a necessity," Tribble explains. "She signed up for Starlink so that she can connect with doctors remotely through telehealth appointments." 

Despite the wait for broadband and the current lack of care access on their lands, tribal leaders say Starlink is too expensive for most of their members.

This year, the Shoshone-Bannock Tribes started work on their high-speed internet installation, but progress will be slow. "To build fiber-optic cables underground, the tribes must navigate lava rock and work with the Bureau of Indian Affairs to get permits," Tribble explains. "Eventually, the old radio station will be central to operations, with fiber-optic cable lines that web out over about 800 square miles to reach the reservation’s five district lodges."

Mental Health First Aid for Rural Communities trains laypeople to be the first line of help

Rural residents can help one another work through
mental crisis or illness by learning MHFA.

Mental health care in rural America has always been more challenging to ask for, find and afford than in more populated parts of the country. A program that trains laypeople may offer rural residents in mentally stressful situations or suffering from untreated mental illness the best path toward getting the help they need.

The National Council for Mental Wellbeing’s Mental Health First Aid for Rural Communities works with "people not necessarily in the health professions to give them the tools they need to recognize and respond to the signs of mental health or substance use challenges," reports Liz Carey of The Daily Yonder. The training teaches participants that while they are not there to treat or diagnosis mental health problems, they are equipped with the skills and knowledge to support a family or friend until professional care is available.

A community that adds this training to its safety net toolbox is spending time incorporating a process that makes a difference. Carey writes, "Studies have consistently shown that it works — more than 90 peer-reviewed studies over the past 15 years have shown that MHFA has a lasting impact."

Jamie Hagenbuch, program manager at the Mental Health First Aid at Madison County Rural Health Council in Cazenovia, New York, told Carey, "I think rural communities definitely don’t have the resources that cities and urban communities do, so having the initial skills to be able to recognize if somebody’s becoming unwell and how to approach them and know what resources do exist, as well as being able to navigate them to those resources, is critical."

Mental Health First Aid training can help "anyone in a rural community to spot the signs of someone struggling with a mental health issue and to be able to step in to help," Carey explains. "A study in 2021 of Cooperative Extension agents in Mississippi found that 62.5% of the participants in the MHFA training programs used their skills six months after training."

Individuals interested in getting training can find more information at https://mentalhealthfirstaid.org

Federal funding cuts, decreased use and a sluggish U.S. economy will cost some rural towns their libraries

The Tieton Library will close later this month, leaving the town's 
1,610 residents without a library for the first time since 1946.

Libraries in rural towns provide residents with a safe community hub that offers educational materials, meeting space, and sometimes even a place to escape inclement weather. But federal budget cuts, a slowing economy and demographic changes are forcing some small-town libraries to close.

Earlier this year, President Donald Trump issued an executive order "dismantling the Institute of Museum and Library Services, which has provided around $270 million a year to public and academic libraries," reports Anna Griffin of The New York Times. Without those federal dollars, some libraries in smaller communities won't have enough funding to remain open.

While Trump's executive order faces a court challenge, some smaller libraries are already scaling back. "Some rural libraries in Florida and Mississippi, for example, have frozen inter-library loan programs, sharply reducing the range of materials available to residents in more remote areas," Griffin writes. "State libraries in Maine, Indiana, Connecticut and Washington have laid off staff members or warned that layoffs were coming."

While most U.S. library systems rely on federal and state funding and already operate within tight budgets, smaller libraries with a more limited tax base have a harder time raising funds to cover shortfalls. 

The Yakima library district in Washington state, which serves rural farming towns, is an example of a system that had to make changes to remain solvent. District leaders have already announced an increase in fees to maintain services. The fee changes, along with looming state and federal funding cuts, have already pushed a Yakima library in Tieton to schedule its closure for later this month.

Kate Laughlin, executive director of the Association for Rural & Small Libraries, told Griffin, "We had a financial model that wasn’t all that sustainable even before this administration. What you are seeing in a place like Yakima County is the start, not the end."

Higher energy prices and older residences mean more rural residents will struggle to stay warm this winter

Many rural residents will struggle to afford heat this winter. 
(Photo by Nadine Marfurt, Unsplash)

Rural residents can struggle to pay their utility bills during the winter months because they face barriers to conserving heat, such as living in older homes or apartments that can be drafty and lack energy-saving features. They are also more likely to have limited access to aid programs designed to help Americans afford energy while avoiding utility debt.

Roughly 80 million Americans have trouble paying their monthly heat and electricity bills. "Now, as the cost of energy climbs, experts say more people are at risk of energy insecurity and poverty, defined by the struggle or inability to keep up with electric, heating, and cooling bills," reports Julia Tilton of The Daily Yonder. 

As electricity and gas rates continue to increase across the U.S., the number of rural residents who can't afford their utility bills has soared. "In the South and Appalachia, rates of severe utility debt were nearly twice as high as of June 2025, per analysis from the Century Foundation economic think tank," Tilton reports. "With winter approaching, home heating costs are expected to outpace inflation."

Maria Castillo, a senior associate on the electricity team at energy think tank RMI, told Tilton, "Who we understand as experiencing energy poverty is unfortunately expanding because of the affordability pressures brought on by rising prices and the volatility of gas prices."

While many rural families qualify for federal utility support through the Low-Income Home Energy Assistance Program, completing LIHEAP paperwork can prevent rural residents from accessing energy aid.

Katrina Metzler, the executive director for the National Energy and Utility Affordability Coalition, told Tilton, "If they’re having trouble affording their utility bills, can they also afford gasoline to get in the car and drive many miles, however many it might be, to reach the office where assistance is available and complete the application?” 

States warn millions of SNAP and WIC recipients that a continued shutdown will pause November benefits

Area food banks are preparing for a surge in need.
(Adobe Stock photo)

At least 25 states issued benefit gap warnings to the more than 41 million Supplemental Nutrition Assistance Program recipients and nearly 7 million families who receive aid from the Special Supplemental Nutrition Program for Women, Infants and Children, known as WIC," report Leah Douglas and P.J. Huffstutter of Reuters.

Minerva Delgado, who directs Alliance to End Hunger activities, told Reuters, "Families are going to be hurt by this should it continue, at a time we know families are struggling to make ends meet."

Food banks in states that issued SNAP and WIC warnings are already hard at work to meet increased demand. But some food pantries already face food shortages due to USDA cuts to its food bank support earlier this year.

Potential loss of grocery benefits would disproportionately hurt rural residents, veterans and elderly individuals who tend to be more dependent on SNAP benefits. Additionally, rural food pantries will face significant supply challenges because they rely more heavily on Department of Agriculture programs and have fewer private donors to help them.

According to Reuters, Agriculture Secretary Brooke Rollins told NewsNation that SNAP benefits would "go away" without a deal to reopen the government by November.

The liberal Center on Budget and Policy Priorities "estimates that about $5 billion is available in a contingency fund and is calling on the administration to use that for partial benefits in November," reports Geoff Mulvihill of The Associated Press. "Forty-six of the 47 Democrats in the U.S. Senate sent a letter Thursday to Rollins calling on her to release the contingency money."

States that issued verifiable benefit loss warnings include: Minnesota, California, Pennsylvania, Texas, California, Arkansas, Hawaii, Indiana, Mississippi, New Jersey, Kentucky, Florida, New York, North Dakota, South Dakota and Wisconsin.

Louisiana, Vermont and Virginia pledged to maintain food aid to recipients despite potential gaps in federal funding.

The Digital Equity Act had its funding axed; programming aimed at rural digital access and literacy is gone

Telehealth appointments can offer rural residents more
frequent visits with their doctor. (Adobe Stock photo)

States used federal funding from the Digital Equity Act grants to help rural residents access technology and learn to use it. But this spring, President Donald Trump declared the program "woke" and canceled its $2.75 billion in funding, reports Sarah Jane Tribble of KFF Health News. The funding cut caused local and state rural digital literacy offerings to close.

The Digital Equity Act cites exactly who the funding is intended to help, including "low-income households, older residents, some incarcerated people, rural Americans, veterans, and members of racial or ethnic minority groups," Tribble explains. "Politicians, researchers, librarians, and advocates said defunding the program . . . jeopardizes efforts to help rural and underserved residents participate in the modern economy and lead healthier lives."

Part of the program had deployed teachers, known as "digital navigators," to help connect rural people with computers, cell phones and tablets, along with the skills to use them. Sam Helmick, president of the American Library Association, "recalled how 'they helped grandpas in Iowa check prescriptions online or laid-off factory workers fill out job applications,'" Tribble writes.

Improving rural health is a key reason advocates have continued to push for digital equality in more remote places. Tribble explains, "Nearly 3 million people in America live in areas with shortages of medical professionals and where modern telehealth services are often inaccessible because of poor internet connections."

When internet access and technology know-how are paired, rural residents can benefit from telehealth appointments, prescription ordering, and easier access to health-related information and monitoring.

Angela Siefer, executive director of the National Digital Inclusion Alliance, told Tribble, "The digital divide is not over." Tribble reports, "The nonprofit filed a lawsuit Oct. 7 seeking to force [the Trump administration] to distribute the money."

Opinion: Rural policing writer disagrees with Wall Street Journal article about rural law enforcement violence

Rural police officers have high rates of shootings, but they 
are also more likely to get shot. (Adobe Stock photo)

A Wall Street Journal story about violence in rural policing gets some concepts right; however, the story's data and overall conclusions are faulty, writes rural police reporter Kathleen Dias in her column for Police1. "I agree with the premise of the article: there really are a lot of harsh interactions between law enforcement and the public in rural places. . . . Where the WSJ writer and I disagree is in the conclusion he draws (that rural cops kill people because they are poorly trained or trained to overreact), the sources for his statistics, and his slant."

"Rural places have high rates of shootings by law enforcement and also of law enforcement officers who get shot; that’s not new information or a new trend," Dias explains. "The writer is also correct that rural agencies frequently lack the ability to use the tools of time, distance and backup to defuse volatile situations."

The article's primary focus is that "rural sheriffs are killing more civilians," Dias adds. "The writer cites Mapping Police Violence stating that since 2013, killings by sheriff’s deputies have risen 43% while killings by police have risen by 3%. . . . First, sheriff’s offices are not all rural [and] not all rural police interactions, lethal or otherwise, are by sheriff’s offices."

Overall, MPV as a source is "profoundly troublesome. 'Police violence' is a broad, provocative term," Dias explains. "The definition from MPV is 'Any incident where a law enforcement officer (off-duty or on-duty) applies, on a civilian, lethal force resulting in the civilian being killed. . . . I found incidents like an off-duty Virginia state trooper who killed a man who was breaking into his home, an off-duty officer who killed his domestic partner and then himself, an off-duty deputy who struck a bicycle rider at night on a Florida highway notorious for wrecks. . ."

The WSJ article uses examples that aren't rural. Dias writes, "The article is about rural police killings, yet the first several quotes are from urban sheriffs about their resources, their experiences and cultural changes they made."

There was an "implicit undertone in the WSJ article’s descriptions of small towns and remote places of the incongruity of violence in those places — that somehow a rural setting made violence even less acceptable than usual," Dias writes. "I believe that underscores the writer’s lack of understanding of rural places, and also the perception of risk by officers."

What rural officers do face is populations that are "more likely to be poor, addicted to alcohol and illegal substances, and to attempt or complete suicide than their urban neighbors," Dias points out. "Rural officers are often poorly paid, and departments do struggle with recruiting, retention and churn that can result in bad hiring choices."

Rural officers need more staff, higher pay, additional training and equipment that works. "I’ll go to the wall with the WSJ writer on those points," Dias adds. "The officers themselves are not the problem. Indeed, they’re expected to be the solution to every problem that comes the way of every other resident, but that’s impossible. They’re cops, not Swiss Army knives."

Read all of Dias' opinion, including her comparison of the WSJ article to a Washington Post story here.

Kennedy pledged to protect Native American health, but staffing and funding cuts have already taken a toll

Navajo Nation leaders took turns hiking alongside Kennedy to detail
the tribal nation’s priorities. (Photo by Katheryn Houghton, KFF) 

Health and Human Services Secretary Robert F. Kennedy Jr. pledged to make Native American health a priority, but federal cuts have already sliced into plans and services tribal members need.

While Kennedy’s intervention saved the Indian Health Service from some government cuts, "health officials across tribal nations say those overtures are overshadowed by the collateral harm from massive cuts to federal health programs," report Katheryn Houghton, Jazmin Orozco Rodriguez and Arielle Zionts of KFF Health News.

Tribal members living in more remote areas will have the most difficulty accessing medical services not affiliated with the Indian Health Service. "Many tribal members don’t live near an agency clinic or hospital. And those who do may face limited services, chronic underfunding, and staffing shortages,” KFF reports. “To work around those gaps, health organizations lean on other federally funded programs.”

"Tribes have lost more than $6 million in grants from other HHS agencies, the National Indian Health Board wrote in a May letter to Kennedy," Houghton, Rodriguez and Zionts write. Across many Native American communities, HHS staffing and grant cuts have chipped away at overdose prevention programs, heat and cooling assistance, and vaccination initiatives.

Native Tribal leaders continue to voice deep concerns over the GOP’s “proposed cuts to Medicaid,” KFF reports. "About 30% of Native American and Alaska Native people younger than 65 are enrolled in Medicaid, and the program helps keep Indian Health Service and other tribal health facilities afloat.”

“Some tribal leaders say the recent cuts, and the way the administration made them, violate treaties in which the U.S. promised to provide for the health and welfare of tribes in return for taking their land,” KFF reports. “Tribal consultation is legally required when federal agencies pursue changes that would have a significant impact on tribal nations."

Despite progress toward universal affordable, high-speed broadband, the rules change again

Photo by S. Dhage

The National Telecommunications and Information Administration (NTIA) on June 6 announced changes to the federal Broadband Equity, Access and Deployment (BEAD) program. Stakeholders have "expressed both outrage and optimism as states search for answers on a path forward," reports Chris Teale of Route Fifty.

Teale writes that the NTIA says its changes aim to "remove regulatory burdens, lower costs and make it technologically neutral."

The government "gave states 90 days to comply," Teale writes. "During that time, they will also have to conduct what NTIA called an additional 'Benefit of the Bargain Round' of subgrantee selection that it said would permit all applicants to compete on a level playing field." 

The latest reforms for the $42.5 billion program work to shift its focus away from restricting state options. "NTIA said it would adopt a 'tech-neutral approach to BEAD, having previously expressed a preference for fiber," Teale explains. "Rules around workforce development, climate and environmental impacts have also been rescinded, as has the approval for Delaware, Louisiana and Nevada’s final plans."

Among the trio of states that already had fully approved plans, Delaware's state broadband office reported it was "reviewing" the new guidance, while Nevada's U.S. Sen. Jacky Rosen said "she would block the nominations of any Commerce Department appointees that oversee or deal with broadband until the state gets its funding," Teale reports. Louisiana's broadband offices have yet to respond. Several states are taking Delaware's lead and say they are in the process of reform review.

Sen. Jacky Rosen

While some politicians and the Internet & Television Association have hailed the changes as a better path forward, "many outside groups have criticized the new BEAD rules," Teale reports. "Jessica Dine, a policy analyst at New America’s Open Technology Institute, said in a statement the new guidance from NTIA 'creates a confusing, last-minute mess of changes. By forcing a rebidding process on an incredibly short timeline, the new policy notice is, in effect, undoing all of the states’ work on their bidding processes so far.'"

The statement by Nevada's Rosen was by far the most outspoken. She said, "I’m beyond outraged that the Trump Administration has moved the goal post yet again. This decision will put Nevada’s broadband funding in jeopardy, and it’s a slap in the face to rural communities that need access to high-speed internet.”

Save the date: On Sept. 17, Rural Assembly Everywhere will focus on abundance during scarcity.

Ready to rumble for rural communities?

Grab a pen or your electronic calendar and save Wednesday, Sept. 17, for attending the virtual Rural Assembly Everywhere. Formal registration is in June.

The day will be a time for rural residents, advocates and friends to learn how to stop asking ourselves, "What now?" and, instead, ask, "What if?" The event will show participants how to promote mutual flourishing and abundance — even during days marked by scarcity.

"Training ourselves to think in this way is challenging when we are surrounded by cultural messages to the contrary. For people in rural communities, scarcity mindset is a common way of life, because resources are often limited," writes Rural Assembly Executive Director Madeline Matson. "Scarcity is real, but how can abundant thinking lead to other gains?"

Everywhere 2025 will highlight stories, tools and resources designed to help rural people counter fears and scarcity mindsets, so they continue to grow their families, farms, vocations, jobs and businesses with renewed and resilient spirits.

Some Everywhere 2025 content is still under construction, and they'd like to hear more rural voices chime in with thoughts, advice, challenges and successes. Matson asks, "Have you encountered zero-sum thinking in your community? How does it show up?" Email Matson at: assembly@ruralstrategies.org and describe what's happening in your rural space, ask questions or submit a discussion topic.

Report: The IRS has gotten better at helping rural and 'underserved' markets but still has room to improve

TIGTA analysis of IRS TAC, VITA, TCI and LITC locations and
SSA shared office space by zip code.

For rural residents, getting help from the Internal Revenue Service might be a bit easier than it was a year ago; however, the agency still needs to  improve its outreach to help "underserved" people, according to the Treasury Inspector General for Tax Administration. Sean Michael Newhouse of Government Executive reports, "A watchdog report published last week offered new insights on how the IRS can better use the nearly $58 billion in funding from the 2022 Inflation Reduction Act to improve taxpayer services for underserved, underrepresented and rural individuals."

While the TIGTA report recognized some improvements, it noted that the "IRS does not currently have a definition for what an underserved taxpayer is," Newhouse explains. "While IRS officials told investigators that they use different models to identify such taxpayers, the inspector general argued this practice has resulted in disparate definitions across the agency."

The report also recommended the agency use strategic communication tools to inform underserved residents about available tax assistance programs. Newhouse reports, "For example, investigators did not find any information on the IRS website about outreach events for rural taxpayers or the agency’s virtual assistance program. That being said, since the virtual service started in 2022, a total of 46 employees have helped more than 22,000 taxpayers."

Because reaching underserved populations is a challenge, investigators suggested the IRS piggyback its office locations with or near other government service offices, such as the Social Security Administration office. 

Latest round of federal grants focuses on communities with less than 10k population; helps with energy bills, projects

Workers in Washington preparing to place underground
electrical lines. (Washington State DOT photo, CC)

The federal government's newest round of grants will invest in communities with less than 10,000 people, with projects aimed at lowering residential energy bills and helping smaller communities transition to renewable energy. "The money will help fund 19 projects in Alaska, Oklahoma, Alabama, Maine and elsewhere," reports Will Wright of The Daily Yonder. "The amount of money being pumped into renewable energy sources over the last few years — particularly in rural communities — is 'game changing,' said Scott Vlaun, executive director of the Center for an Ecology-Based Economy, one of the grant recipients."

The energy installations will reach some areas that have never had electrical power before. Wright explains, "In Washington's Ferry and Okanogan counties, part of a $5 million grant is dedicated to extending underground electrical lines to about 135-190 homes that will gain access to electrical service for the first time." The Northeastern Washington counties are some of the state's poorest.

Money for rural solar will help residents and educational facilities save money. "Maine will receive about $3 million to install small solar projects that will help local families get cheaper electricity and, in some cases, allow families to move away from other, more harmful heating sources like kerosene," Wright reports. "At Mississippi's East Central Community College, a $2.8 million grant will help pay for solar installations that can provide clean power to 38 campus facilities."

This latest round of grants represents a shift in the way the applications were designed to help rural communities — especially those with a lower capacity to apply for grants — get through the grant-request process. "But in communities like those in western Maine serviced by the Center for an Ecology-Based Economy, Vlaun said this round of grants could have a big impact on the everyday lives of many rural residents," Wright adds. "Whether the current enthusiasm to spend federal dollars on renewable energy will continue may depend on the outcome of the November election, he said, and the effectiveness of propaganda aimed at reducing confidence in renewable energy."

Learn how to investigate the who, what, when, where, why and how of the 2024 elections on Wednesday, April 24

Learn how to prepare for the 2024 elections when news coverage is scarce. You can register for the News Literacy Project's free online educational session on Wednesday, April 24, at 6 p.m., E.T., 

Register here.

As mainstream and local news outlets have shrunk nationwide, more rural Americans find themselves in news deserts, where trustworthy local news is scarce. Particularly for rural residents seeking 2024 election information, navigating away from partisan politics and social media rumors and getting to actual facts might seem like finding a black cat in a coal mine.

As an antidote to no news or fake news, the News Literacy Project is holding an educational session to help residents learn ways to prepare for November's ballot. The session will include advice from three experts – Benjy Hamm, director of the Institute for Rural Journalism and Community Issues at the University of Kentucky; Alana Rocha, editor of the Rural News Network; and Brianna Lennon, county clerk for Boone County, Missouri and co-host of the podcast "High Turnout Wide Margins."

Speakers will walk listeners through how people living in news deserts or other areas with limited access to elections coverage can prepare to vote in 2024. Participants will learn about obstacles to finding credible information and what tools are available to citizens to investigate the who, what, when, where, why and how of the elections.

Working-age rural residents are dying at 'wildly higher rates' than their urban counterparts; cause is undetermined

Photo by M. Vistocco

U.S. mortality rates can fall into two very different camps -- rural working-age death rates and everyone else's death rate. "Rural Americans age 25 to 54 — considered the prime working-age population — are dying of natural causes such as chronic diseases and cancer at wildly higher rates than their age-group peers in urban areas, according to a new report from the Agriculture Department's Economic Research Service," reports Jazmin Orozco Rodriguez of KFF Health News.

To compare the two groups, "USDA researchers analyzed mortality data from the Centers for Disease Control and Prevention from two three-year periods — 1999 through 2001, and 2017 through 2019," Rodriguez explains. "In 1999, the natural-cause mortality rate for rural working-age adults was only 6 percent higher than that of their city-dwelling peers. By 2019, the gap had widened to 43 percent." 

In reviewing demographic differences, Native American women fared the worst, but overall, a link between younger rural deaths and a lack of Medicaid expansion could be part of the cause. "USDA researchers and other experts noted that states in the South that have declined to expand Medicaid under the Affordable Care Act had some of the highest natural-cause mortality rates for rural areas," Rodriguez reports. "But the researchers didn’t pinpoint the causes of the overall disparity."

Another possible connection could be the lack of rural health care options and rural hospital closures. "Alan Morgan, CEO of the National Rural Health Association, and other health experts have maintained for years that rural America needs more attention and investment in its health care systems by national leaders and lawmakers," Rodriguez adds. "It’s unlikely that things have improved for rural Americans since 2019, the last year in the periods the USDA researchers examined. The coronavirus pandemic was particularly devastating in rural parts of the country."

'On the Front Porch' hosts author Carol Graham to discuss the dramatic impact of hope -- or the lack of it

Why are there pockets in the United States with a striking number of "deaths of despair"? How is despair defined? What are some possible shifts in approach and policy that might taper and prevent the onset of despair?

This Thursday, March 14, at 4 p.m. E.T., Professor Carol Graham of the Brookings Institution will join Tony Pipa from Reimagine Rural and Brent Orrell of the American Enterprise Institute in a deep-dive discussion of her new book The Power of Hope: How the Science of Well-Being Can Save Us from Despair, which incorporates hope as a metric of economic and social well-being.

Register here to participate in person at AEI or online.

On Thursday, April 4 at 10 a.m. E.T., author, speaker and researcher Elizabeth Currid-Halkett will join On the Front Porch for a discussion of her book, The Overlooked Americans, which focuses on surprising successes in American small towns and how that influences the country. Register here to join the conversation.

Wealthier, more metro residents have access to local news, while lower-income communities often live in news deserts

Medill Local News Initiative map, from Local News Initiative data

As local news outlets dwindle, lower income residents are more likely to live in a news desert than wealthier residents, who are more likely to live near or in a metro area. "The State of Local News Project at Northwestern University documents the changing local news landscape across the country. Our latest report shows that where you live and how much money you make affect whether you live in a news desert or a news oasis," reports project director Sarah Stonbely for The Conversation, a journalistic platform for academics. "This divide is related to other factors affecting the health of our democracy, as analysis of our data by the nonprofit Rebuild Local News showed."

The expansion of news deserts means areas have no outlets reporting on local news or civic meetings that help residents stay informed and involved in the democratic process. Regional news revenue has shrunk as social media has taken chunks of advertising dollars without investing in local communities.

Without ad revenue, "Many outlets rely on audience funding, philanthropy, cost-cutting or some combination of the three," Stonbely explains."In communities with little disposable income for news subscriptions or donations and no local philanthropies, cost-cutting becomes the only option. This creates a self-reinforcing spiral of lower quality and declining readership and, ultimately, closure."

Right now, the determining factor between news haves and have-nots is money. Stonbely writes, "Wealthier communities do better sustaining local news organizations. . . . An example is the Moab Sun News, which is thriving in the rural rocky highlands of Utah, thanks in part to a robust tourism industry and retail base. Though it serves a relatively small permanent population of 5,321, the Moab Sun News has built a sustainable business model."

For some news outlets, the current market is not sustainable. "All told, 1,558 of the nation's 3,143 counties have only one news outlet, while 203 are news deserts with zero, meaning there are likely thousands of communities that simply do not have access to local news," Stonbely reports. "For example, Texas and Tennessee had four counties lose their only remaining newspaper last year. All eight papers were independently owned."

Despite the tough market, ways to help sustain local journalism -- especially in challenging markets are emerging. Collaboration is one way. "In Colorado, the national nonprofit news outlet The Daily Yonder has hired a reporter based in a rural community to write stories about life there and share them out with both local and national organizations," Stonbely reports. Another option is philanthropic support. "Public policy should also play a role. At the state level, policies to support local news have seen success in New Jersey, California and elsewhere, and more bills are working their way through state legislatures."

Hoarding disorders are more easily hidden in rural communities and getting treatment is more challenging

A hoarding disorder can be less visible in rural places.
(Photo via RHIHub)

Some people have a lot of stuff, but too many piles of too many things may be evidence of a hoarding disorder. For rural residents, who skew older and have more available storage space, hoarding can mean "unseen" health and safety risks," reports Gretel Kauffman for Rural Health Information Hub. "About 2% percent of the general population experiences hoarding disorder. Among older adults over 55, the prevalence rate jumps up to more than 6%, making people increasingly vulnerable to the disorder as they age."

Hoarding disorder is a relatively new diagnosis. It was added to Psychiatry's Diagnostic and Statistical Manual of Mental Disorders in 2013. The DSM defines hoarding disorder as "persistent difficulty discarding or parting with possessions, regardless of their actual value. . . due to a perceived need to save the items and to the distress associated with discarding them. . . . It causes clinically significant distress or impairment . . . including maintaining a safe environment for oneself or others."

Letting go of things can be emotionally charged, and as people age, they may become physically unable to move items from their homes, which can add to distress. "Left untreated, the disorder can lead to health risks, such as an increased risk of falling, fire hazards, food contamination, poor sanitary and hygienic conditions, trouble keeping track of medications, and infestations of mold, insects, or rodents. It may exacerbate other conditions such as depression and anxiety," Kauffman explains. "In rural settings, identifying and reaching people struggling to part with their possessions can be extra difficult . . . . And getting someone into treatment in the first place can be a challenge."

Because remote areas offer so many unique "homes" for saving things -- barns, smokehouses, sheds, unoccupied houses, and even corn cribs -- sometimes family and neighbors have no idea how much stuff is being hoarded. Catherine Ayers, a professor of psychiatry at the University of California, calls the diagnosis "unseen." She told Kauffman, "It's not bothering other people, because there's so much space. They don't have a neighbor that is having roaches or bedbugs come over, so there's no urgency yet."

It's important for family, friends and providers to keep in mind that a hoarding disorder is harmful. Kauffman adds, "To identify and treat hoarding disorder early on, Ayers recommends that primary care providers ask all of their patients a few simple, non-stigmatizing questions, such as, 'Does the number of possessions you have in your home make it difficult to use the rooms in the way they're intended?' or 'Have friends and family members complained that you have too many items in your home?'" For people seeking treatment in more remote areas, telehealth and remote learning can be treatment options.