8 rural-related stories win Sigma Delta Chi awards, including reports on ICE, inequalities, firefighters, environment, etc.

Illustration from ProPublica story about Hurricane Helene and Yancey County, North Carolina

Eight rural-related stories were among winners of Sigma Delta Chi Awards for 2025, announced Thursday night by the Society of Professional Journalists (formerly Sigma Delta Chi) and the SPJ Foundation.

Investigate TV+, a unit of Gray Television, and KFF Health News won the award for broadcast coverage of inequalities in society with a package of three stories called "Dead Zone," explaining that millions of Americans "live sicker, shorter lives in hundreds of rural counties where doctor shortages are the worst and poor internet connections mean little or no access to telehealth services."

The award for public-service radio reporting in small markets went to North Country Public Radio of upstate New York for its report on the ICE raid on a dairy farm, which led to the release of a motherf and three children who were in a detention center awating deportation. "This issue is one that's forcing dairy farmers to sell their herds," the judges wrote. Here's the summary of the coverage and reaction.

Jennifer Berry Hawes, Cassandra Garibay and Mollie Simon of ProPublica won for "Helene's Unheard Warnings" in the category of non-deadline reporting in a publication with a print circulation of more than 40,000 or an online-only piublication. Their package of stories spotlighted the lack of evacuation orders, the hurricane's devastation and survival stories in Yancey County, North Carolina.

Hannah Dreier of The New York Times won the Public Service in Journalism award for her stories on the suffering of firefighters sent into fires by the U.S. Forest Service without warnings of toxic smoke and gases, and with a ban on wearing masks.

Dave Biscobing of KNXV in Phoenix won the large-market TV feature reporting award for his investigation of the sheriff in Prescott, Ariz., pop. 46,000, and "one man’s fight to prove self-defense against a top small-town fire official," as the report describes it.

The award for TV feature in small markets went to Kevin Kelly of KLRT in Little Rock for his story about a family in Vilonia, Ark., who saw their home and classic-car collection devastated by a tornado that killed nine people and injured dozens more in the town of 4,500. They restored the four cars a second time.  

Elise Plunk of the Louisiana Illuminator, Eva Tesfaye of WWNO in New Orleans and Chas Sisk of the Mississippi River Basin Ag and Water Desk won an award for a story on how an accidental delta taught scientists how to rebuilt wetlands. They won in the category for science or environment reporting in a publication with a print circulation up to 40,000 or an affiliated website.

The broadcast award in that category also went to a Louisiana story, "The True Cost of Fertilizer,"
by Garrett Hazelwood and Eric Schmid of "Sea Change" at WRKF in Baton Rouge and WWNO, with support from the Mississippi River Basin Ag and Water Desk, based at the University of Missouri.

The awards program also included announcement of the top Mark of Excellence Award for College Journalism, which went to a rural story: "Broadband’s broken promise: How federal failures and funding fights keep Native and Black farmers offline," done by Melissa Dai of Northwestern University during her summer internship with Investgate Midwest. The story had won the MOE award for investigative reporting, then was judged to be the top piece of college journalism in 2025.

Rural areas lead decline in Obamacare policies' enrollment

As enrollment in Obamacare health-insurance policies declines nationwide, rural areas are leading the fleeing, Sarah Melotte reports for The Daily Yonder and its Rural Index.

The Affordable Care Act policies have become less affordable because Congress did not renew premium subsidies that were implemented during the Covid-19 pandemic and extended in the Biden administration.    "People who are no longer eligible for these subsidies have accounted for a disproportionate share of health insurance coverage drops, resulting in increases in monthly premiums for nearly all consumers." Melotte reports.

Melotte looked at the 30 states that used the national marketplace platform for Obamacare policies and found a 12 percent drop in rural counties, defined as those outside metropolitan areas, "representing 29,000 consumers," she writes. "Small metropolitan counties saw a drop of 11%, representing about 154,000 consumers, the next largest decrease in enrollment among all of the county types."

(Charts by Sarah Melotte, The Rural Index)

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.

Babies delivered at rural hospitals can receive specialized neonatal care through a unique telehealth program

A newborn baby's care team can get live, immediate help
from a neonatologist with TeleICN. (Dartmouth photo)

A pregnancy delivery in a rural hospital far away from specialized care poses significant risks for a baby born with complex needs. In Vermont and New Hampshire, Dartmouth Health created TeleICN, a unique telehealth program that connects rural medical providers to neonatologists who can help manage a baby's health during and after delivery, reports Christopher Cheney for Healthleaders.

As more rural hospitals have cut services to save money, many have shuttered their labor and delivery units. In the case of an emergency delivery, EMS will take a pregnant patient to the nearest emergency department, where a rural care team can "connect to the TeleICN program using an iPad or making a phone call," Cheney explains.

Tapping into TeleICN is similar to using FaceTime. The program allows a neonatologist to "talk with the local teams, look at the baby via video, and work with the mom and their family members to make decisions about the next steps in care for babies," Cheney reports. TeleICN can "connect local care teams to a neonatologist virtually on a 24/7 basis, and it serves 16 rural hospitals in New Hampshire and Vermont."

Katelyn Darling, a director at Dartmouth Health, shared the varying levels of care TeleICN often provides, saying, "Sometimes, they know a mom in labor is on the way to their hospital, and they want us to help them prep the care room. Sometimes, they want us in the background to support them. Sometimes, they want us on the frontline making decisions about care."

Because the TeleICN has been so successful, Dartmouth expanded its virtual obstetrics care with its new TeleMFM program. Cheney explains, "The focus is on high-risk obstetrics care and fetal-maternal medicine services, with the goal of reducing the need for patients to travel long distances. … Patients can go to a clinic associated with a rural hospital and get connected to a TeleMFM provider."

Jessica Clem, TeleICN's medical director, told Healthleaders, "What we are trying to do is provide equitable care in New Hampshire and Vermont, particularly for rural communities."

Too few childcare workers and the extreme cost of childcare are hardest on rural families. Utah is an example.

The childcare shortage is more dire in
rural areas. (Photo by Kracken, Unsplash)

Across the U.S., roughly 51% of American families live in a childcare desert, and 70% of rural parents report struggling to find any licensed caregivers with an opening, according to a new survey from the Center for American Progress. And even when parents are lucky enough to find a provider, they often struggle to afford it.

Both issues — the cost of care and the childcare worker shortage — are particularly acute in Utah, where "licensed providers meet only about 36% of the need, with rural communities facing significant shortages," reports Mark Richardson of UPR, which serves Utah and Southern Idaho.

Casey Peeks, the center's senior director of early childhood policy, told UPR, "You can make childcare free for every family living in a rural community tomorrow, but that's not going to solve the access." Peeks said that while addressing cost is important, developing and supporting childcare workers is equally vital.

Like many other states, the lack of childcare workers hurts Utah's treasury. "The childcare shortage costs Utah an estimated $1.3 billion each year in wages and productivity," UPR reports.

Utah lawmakers have been working to address childcare expenses by "expanding tax credits for employers that provide childcare, increasing the Child Tax Credit, and extending paid maternity leave for state employees," Richardson explains. But none of those changes increase the number of childcare workers.

To increase the number of childcare providers, the profession needs to be reassessed both in terms of importance and wages. Hailey Gibbs, associate director of the center's early-childhood policy team, told UPR that workers are often seen as getting "paid to play." Richardson adds, "The annual cost of childcare in Utah is between $7,000 and $10,000. A childcare worker is paid about $15 an hour on average."

Policymakers and voters need a better understanding "about child development and the needs of young children," Gibbs told Richardson, "and also the returns that children see in their education, in their health outcomes, even in their adult earnings when they have these kinds of really enriching early opportunities.”

Richardson adds, "Gibbs said the data shows the need for comprehensive solutions that address both cost and availability, starting with better wages for childcare professionals."

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."

Quick hits: SS Edmund Fitzgerald mystery remains; internet carriers team up; complex beef pricing; what to wear for extreme-weather reporting

At 729-feet, the SS Edmund Fitzgerald was the longest ship traveling through the Great Lakes
before it was 'swallowed' by Lake Superior. (Wikipedia photo) 

It's still a story investigative reporters are exploring: What caused the massive SS Edmund Fitzgerald to sink 17 miles from the safety of Whitefish Bay, Wisconsin? "On November 9, 1975, the ship left Superior, Wisconsin, with more than 26,000 tons of taconite pellets aboard. By the next evening, Lake Superior had swallowed the Edmund Fitzgerald whole," reports Andrew Daniels of Popular Mechanics. "One answer may be the ship’s cargo hatches. Ric Mixter, who visited the Fitzgerald wreck in the 1990s, said that if he could return, he would take photos of every hatch clamp and investigate where the taconite ended up." Read Pop Mech's deep dive on the famous ship's final voyage here. Listen to Gordon Lightfoot's haunting ballad about the fate of the Edmund Fitzgerald and its 29-member crew here. 

It's expensive for U.S. ranchers to increase their herds.
(Photo by Daniel Quiceno M, Unsplash)

Why can't farmers just raise more cattle so the price of beef will come down? "Ranchers say it's not that simple," reports Jack Dura of The Associated Press. "It’s never been so expensive for Americans to buy a steak or hamburger. … The dwindling number of cattle is a key reason the average price of all uncooked ground beef in the U.S. was $6.86 per pound in March." Even with high beef demand and high prices, ranchers still have to consider the cost of adding to their herd. Livestock owners are already paying more for the cattle they do have because drought and wildfires have left ranchers no choice but to pay for additional feed and water to be delivered to herd sites. 

Despite efforts to get the entire country online, many U.S. residents still live in areas without internet access, but that problem could soon change. AT&T, T-Mobile and Verizon Communications announced that they are "setting aside their differences and forming a joint venture that will help end wireless dead zones across the U.S., especially in rural and underserved areas," reports Connor Hart of The Wall Street Journal. "The companies said the initiative will help the U.S. extend its global leadership in wireless communications technology … "

Handwritting letters is good for the human brain.
(Photo by T.D. Aran, Unsplash)

Handwriting letters may seem more than a trifle old-fashioned, but revisiting the aged tradition of letter, pen and stamp can reap benefits. Elizabeth Passarella of The New York Times writes, "Research shows that writing by hand lights up multiple parts of your brain — areas that are associated with creativity, memory and your senses — in a way that emailing does not. … Unlike chatting, writing makes you slow down and decide which details of your life are meaningful enough to share." Readers interested in tips to get started with a letter-writing habit can click here.

Whether it's tornado, wildfire or hurricane season, journalists need to be ready to hit the natural disaster beat. But first, preparations need to be made, and extreme-weather reporter Judson Jones is here to help reporters look good no matter what Mother Nature blasts. "Shortly after returning from a trip to chase hailstorms, Jones gave me a rundown of his core outfit packing list that keeps him ready for any assignment," reports Kyle Fitzgerald of Wirecutter. "We talked about why the way he unpacks is as important as the way he packs, as well as the need to bring multiple hats." After years of trial and error, Jones has even found a jacket that keeps him dry during hurricane rain and winds and is stylish enough to wear to dinner post-storm reporting. Read his picks and tips here. 

The world loves American cheese and butterfat products.
(Photo by Edward Howell, Unsplash)

Global cheese and butterfat demand continues to climb, helping American dairy farmers slice off profits even as milk production continues to increase. Cheese exports in March broke records with "over 63,435 metric tons exported, which is an all-time high for single-month exports," reports Sarah Jungman of Dairy Herd Management. The 2026 gain represents a 29% jump in cheese exports over March of 2025. "Butterfat and anhydrous milk fat exports also set a single-month record at 17,074 metric tons shipped, 109.9% higher than March of 2025." During the first quarter of 2026, Mexico exported the largest chunk of American dairy products. 

More selective colleges aim to get rural students who've been accepted to take the leap and enroll

Rural students accepted to selective Amherst College make 
s'mores and discuss their futures. (Photo by Lucy Lu, Hechinger)

Prestigious colleges throughout the U.S. are increasing efforts to convince more rural high school seniors to not only apply for admission but to enroll upon acceptance. Student and family support initiatives are being created to help those seniors take the leap, reports Jon Marcus of NPR in collaboration with The Hechinger Report.

Roughly three years ago, a full-fledged initiative known as the STARS College Network — for the Small Town and Rural Students — was launched by rural-born philanthropist and University of Chicago trustee Byron Trott, who invested $20 million to start the program, Marcus explains. During its first three years, STARS aimed to help more rural students learn what more elite colleges were offering and apply.

Even though more rural high schoolers graduate than their urban and suburban counterparts, getting rural students to consider and apply to colleges like Brown, MIT and Yale is a tall order. "Ninety percent of rural students graduate from high school," Marcus reports. "But only a little more than half go straight to college."

The reasons rural high school graduates avoid colleges, particularly those that are more selective or far away from home, are complex and can range from being scared off by tuition costs to not even knowing where to start applying. Nonetheless, the STARS College Network has made progress. Marcus adds, "As STARS has built momentum, more than 90,000 rural students applied to its member institutions last year, up 15% over the year before."

But STARS leadership saw a gap. Even when rural students were accepted to more elite colleges, they did not enroll. New funding from the Trott family is working to change that. Marcus reports, "Trott's foundation has since injected another $150 million into STARS, which has expanded from 16 member schools to 32."

To encourage accepted students to enroll, some STARS colleges are covering the costs for "prospective students and admitted applicants from rural areas to spend a day or two on their campuses," Marcus explains. "More than 1,000 students took advantage of that opportunity last year."

Not only does adding rural students to a selective college body help rural students and families achieve upward mobility, but it also helps colleges create a more diverse set of opinions and learning experiences for all students. Michael Elliot, the president of prestigious Amherst College in Massachusetts that participates in STARS, told Marcus, "Students growing up in rural areas bring perspectives and experiences that students from urban environments don't have."

Survey: Seniors, rural residents and renters face the 'devasting impact' of inflation

Rising gas and grocery costs hit lower-income Americans 
harder. (Photo by rc.xyz NFT gallery, Unsplash)

Even before the Iran war, seniors and rural families were struggling to afford basics such as groceries, gas and rent. With the Strait of Hormuz closure, more Americans are under financial strain, but the higher costs hit lower-income people and families harder.

Data released by the U.S. Census Bureau's American Community Survey shows "certain groups of Americans are falling behind financially, with seniors, renters and people living outside metropolitan areas facing particular hardships," reports Stephanie Liebergen of Scripps News. The survey gathers demographic, social and economic data on Americans over five-year time spans.

Between 2020 and 2024, the "poverty rate for seniors rose in more than 800 counties when compared to the five years before, according to the survey," Liebergen writes. "Inflation wiped out almost all income gains for older Americans during this period."

Rural Americans' finances also lost ground because of lower or stagnant wages. Liebergen explains, "The median household income in large metro areas is 30% higher compared to households in rural communities, according to the new data." Renters, who tend to fall into lower income brackets, also got pinched. 

Eric Pachman, a data expert who analyzed the survey's results, told Scripps, "What the story really is, and what's really hitting me very hard right now, is the devastating impact of inflation on people at lower income brackets."

The survey does not include details on the 2025 tariff wars and the 2026 Iran war. Those two impacts have driven inflation higher, leaving more Americans spending a higher percentage of their incomes on gas and groceries.

Consumer prices across the U.S. rose at the "fastest rate since May 2023 last month, as sharp increases in energy costs caused by the war in the Middle East," reports Lydia DePillis of The Wall Street Journal. "Average gasoline prices are above $4.50 per gallon, while diesel prices have nearly doubled. . . .Grocery costs rose 2.9% since last April."

After four years and many obstacles, 'Internet for All' is unlikely to reach every American

BEAD may not be able to live up to its 'Internet for All' promise.
 (Photo by Jay Heike, Unsplash)

After years of planning and delays, most states have accessed at least a portion of their federal grant funding from the $42.45 billion rural broadband expansion program. Some states are likely to break ground later this year, while others continue work to lock in approvals and installation contracts.

"States have six months to finalize contracts with participating internet service providers and complete required environmental and historic reviews, before construction can begin," reports Jericho Casper of The Daily Yonder.

It has been more than four years since the Biden administration announced the Broadband Equity, Access, and Deployment (BEAD) program. Since then, it has gone through multiple phases and two presidential administrations. The Trump administration mandated that states trim their requests, meaning only half of the program's funding has been sent or awarded to states.

With roughly half the money spent, many state planners are wondering: What happens to the $22 billion in unspent funds? Casper explains, "The U.S. Commerce Department put the funding aside for "so-called 'non-deployment' uses,'" but what those are has remained unclear.

Lawmakers asked Commerce Secretary Howard Lutnick to explain what states can expect the funds to cover, but "he offered few specifics, saying only that guidance would come within two months," Casper reports. Lutnick did say that "states would be able to pursue 'new and exciting things' with the money."

Meanwhile, delays and uncertainty are likely to hurt programs already underway. Casper writes, "State broadband offices in Colorado and New Mexico report that some providers who initially expressed interest may ultimately default on preliminary awards."

Providers have seen their costs multiply over time and may be rethinking their bids. Casper adds, "Fiber suppliers say prices have jumped as much as 40% in recent weeks. . . . For some providers, particularly those serving remote areas, the administrative burden may outweigh the benefits."

The program's complexity and legislative heavy lifting continue to slow its progress. "Industry experts have described BEAD as the 'most complicated broadband grant program ever,'" Casper reports.

And while lawmakers have tried to speed the process, legal battles with local governments and industry providers over broadband permits continue. Casper adds, "The program once billed as 'Internet for All' is expected to reach fewer households and businesses under the revamped plan, and experts say closing the remaining gaps will require sustained investment."

Quick hits: USDA plans fertilizer production in U.S.; farmers' 'stops' that aren't seasonal; curiosity builds community

Brooke Rollins

The Department of Agriculture plans to use tariff dollars and trade renegotiation resources to help fertilizer production in the United States. Agriculture Secretary Brooke Rollins said the "USDA is focused on helping move fertilizer supplies more quickly, but cautioned it will take time for crop nutrient prices to begin falling," reports Kim Chipman of AgriPulse. "Rollins said she hosted a meeting with executives of four top fertilizer companies and Commerce Secretary Howard Lutnick, U.S. Trade Representative Jamieson Greer and National Economic Council Director Kevin Hassett." The Trump administration hopes to roll out its full plan to move fertilizer production back to the U.S. sometime this week.

The University of Maine's Fort Kent campus will provide dorms,
 a lounge and a cafeteria for recovering teens. (UofM photo)

Just like some adults, preteens and adolescents can end up with severe drug and alcohol addictions that can end in an overdose or many failed recovery attempts. Recovery advocates in the tiny town of Fort Kent, Maine, will "use new funding to try a novel solution to the problem: a public boarding school for high schoolers in recovery," writes Lanan Cohen for The Hechinger Report. The new approach will "focus on abstinence and mental health to help students overcome their substance abuse problems." Educators hope the boarding school structure will allow students time to solidify new choices and coping strategies while remaining in school.

Graphic by A. Dixon, Offrange

It's not a farmers market. It's a farmers "stop," and it's open all year long. Farming advocates hope the concept continues to catch on. "The Argus Farm Stop model is built on a consignment basis with a 70/30 split: Farmers set their own prices and keep 70% of every sale, while Argus retains 30% to cover operating costs," reports Heidi Roth for Offrange. "A café inside each location accounts for roughly a third of sales but about half the profit, effectively subsidizing higher farmer payouts while creating a community hub where farmers can gather, and customers can meet producers." Not all farmer stops have the same elements, but all aim to support local farmers while fostering community spirit.

Musical talent from far-flung places often took center stage at the Big Ears festival in Knoxville, Tennessee. "The festival is rich with rural tradition, pulling in rural musicians from across the states and every continent except Antarctica (as far as I know)," reports Phillip Norman of The Daily Yonder. "I caught an ambient country jam by Setting in the backroom of Boyd’s Jig and Reel Scottish Pub, and hit the Knoxville Art Museum to witness the electric saxophone wizardry of Sam Gendel. . . . Big Ears is a festival for music nerds who are interested not only in how a concert sounds, but also how it reflects the lived experiences of the people making the music."

Beth Howard (Illustration by N. Nichols)

As an activist and community organizer for Appalachia and the broader South, Beth Howard hopes her memoir, Song for a Hard-Hit People: A Memoir of Anti-Racist Solidarity From a Coal Miner’s Daughter, helps readers see Southern differences through a lens of curiosity that they can apply to their daily interactions with other people, writes Nhatt Nichols of Rural Assembly. Howard said, "I think one of the biggest lessons for me when I was learning to organize is the importance of listening and asking really good, open-ended questions." Nichols adds, "Howard advocates for getting out into your community and finding other people who are doing organizing work that resonates with you, and offering to lend a hand, to learn more about your community without centering your own ideas."

When dialysis treatment centers close, rural patients have no choice but to drive further for care

After the Chadron dialysis center closed, Pieper's 
treatment travel time tripled. (KFF Health News photo)

Rural residents who require dialysis treatment to stay alive are having to drive longer distances for care as smaller hospitals and clinics shed unprofitable services to stay afloat, reports Ariella Zionts of KFF Health News.

When Chadron Hospital shuttered its dialysis center, which served Nebraska residents in the state's far western panhandle, Mark Pieper became one of the many displaced patients who would have to find another dialysis center for treatment.

Because the human body cannot survive without kidney-like functions that filter toxins, remove excess fluid and balance electrolytes, dialysis cannot be rescheduled or skipped. When faced with the closure of their dialysis center, renal patients like Pieper have two choices: Travel for treatment or die.

"Pieper eventually found treatment in Scottsbluff, which, with about 14,000 residents, is the biggest city in the rural Panhandle region," Zionts writes. "The hour-and-a-half drive will triple his time on the road to more than nine hours each week."

Chadron Hospital discontinued its dialysis service despite the $219 million in federal money Nebraska will receive this year from the Rural Health Transformation Program. But RHTP awards aren't meant to "help existing services stay afloat," Zionts explains. Instead, they are earmarked to help rural medical centers "explore new, creative ways to improve rural health." Only 15% of RHTP funds can be used to pay for patient care.

Chadron Hospital was "losing $1 million a year on its dialysis service due to low reimbursement rates that didn’t cover operational costs," Zionts reports. Nephrologist Mark Unruh said the "dialysis closure in Chadron reflects a wider trend of staffing and funding challenges."

Preventing kidney failure is one of the best ways rural areas can change what rural dialysis patients like Pieper are facing now, Unruh told KFF Health News. "He pointed to a tele-education program that helps primary care doctors in rural and other underserved areas prevent end-stage renal failure."

A small infusion clinic in rural Texas helps cancer patients not have to drive hundreds of miles a week for care

New Jersey and Rhode Island do not have rural hospitals and are excluded from the analysis.

(Map by Deidre McPhillips, CNN, from Chartis data)

Rural cancer patients often drive hundreds of miles for treatments only bigger cities can offer, but a smaller hospital that chose to add an infusion clinic in a rural area shows that cancer care can move closer to home, reports Caleb Hellerman of CNN News.

Childress Regional Medical Center, which serves roughly 30,000 people in a 5-county region of North Texas, did the opposite of what many smaller hospitals have been doing. They added services instead of shrinking them. Hellerman writes, "Childress [began with] opening a small infusion center in 2013 and steadily expanding its capabilities in order to serve patients."

When it comes to diagnosis, treatment and survival rates, rural cancer patients are already at a disadvantage. Hellerman reports, "Rural cancer patients tend to be diagnosed later and have worse outcomes. . . . Rural patients are also less likely to receive treatment that meets the standard of care."

Although the Childress infusion clinic started small, the need for it quickly became apparent, and its provider count grew to meet the needs of rural patients. Hellerman explains, "The infusion center started with two chairs but has since grown to encompass 10 spots for patients, three full-time pharmacists and three full-time oncology nurses."

Residents in the region are luckier than many of their rural peers. The medical consulting group Chartis "found that 448 rural hospitals – nearly a quarter of the nation’s total – stopped offering chemotherapy services between 2014 and 2024," Hellerman writes. Out of all the states, Texas lost the most.

Beyond the transportation issues, rural cancer patients will continue to face a dwindling number of oncologists willing to practice in rural regions. Some of that shortage is attributed to younger specialists preferring to live and work in more urban areas. But, according to Hellerman, the high cost of cutting-edge cancer drugs is also preventing younger oncologists from considering rural-leaning positions. 

"Oncologists and hospital administrators say pressures are likely to worsen over the next few years as provisions of the 'Big Beautiful Bill' kick in," Hellerman reports. Most of those cuts are slated to come from reducing the number of Americans who receive Medicaid.

After being dropped by their Medicare Advantage Plan, millions of seniors were left scrambling for health insurance

Some rural residents can no longer enroll in Medicare
Advantage Plans.

Privatized Medicare coverage, also known as Medicare Advantage Plans, stopped providing health insurance to residents in counties where profits were too slim or nonexistent. The shift in coverage options has disproportionately affected rural residents, reports Christopher Rowland of The Washington Post.

Over the past 20 years, Medicare Advantage Plans have grown exponentially by offering extra perks and low premiums to seniors seeking health care coverage that provides more benefits than traditional Medicare, but that trend has reversed. Rowland explains, "Insurers sharply retreated from the plans in some regions, saying rising health care costs and reduced government reimbursements have hurt profitability. . . . Hardest hit were a half-dozen rural states from New England to Idaho."

The sudden change "highlights one of the risks for Medicare Advantage beneficiaries, especially in rural areas where options tend to be meager: plans are under no obligation to offer coverage year-to-year," Rowland reports. "When profit margins are threatened, insurance companies can suddenly withdraw coverage."

Many rural counties have been the first to be cut off, leaving residents with traditional Medicare Part B, which has an 80/20 split, as their only option. Many seniors fear their 20% share will leave them with large medical bills.

In 2026, nearly 3 million people, or 10% of Medicare Advantage Plan beneficiaries, were dropped and forced to find other health care coverage, Rowland reports. "That’s a big jump from 2018 to 2024, when the rate of involuntary terminations was below 2% each year."

After 30 years, this rural hospital reopened its maternity unit

Dana Iglesias, medical director of the UNC Health Chatham Maternity Care Center, left, and Beverly Carpenter, the unit's manager, stand inside a labor and delivery room. (Photo by R. Crumpler, NC Health News)

UNC Health Chatham in North Carolina closed its obstetrical unit in 1991 after years of staffing shortages and poor financial performance. For 30 years, moms and families had to drive farther for care and delivery, while UNC hospital leadership continued to work on how to make maternity care fit in a rural hospital setting. 

After decades of consideration, UNC hospital leadership and medical providers decided to alter their obstetrical unit's staffing structure to make it more versatile and affordable. UNC Health Chatham reopened its mother-baby unit in 2020. Rachel Crumpler of NC Health News reports, "Births at the unit have increased each year since it opened, reflecting demand for local maternity care."

The unit is created to be sustainable and flexible. Crumpler writes, "It serves low-risk mothers and newborns and is staffed by family physicians trained in obstetrics and surgery, along with midwives — a lower-cost model than one centered on OB-GYNs, who cost more to employ and are harder to recruit to rural areas." 

Because family medicine doctors are trained across multiple medical specialties, their versatility helps them meet the two-patients-at-once demands of obstetrical care. Additionally, their salaries are lower than OB-GYNs, "meaning delivery volumes don’t need to be as high for the unit to be financially viable," Crumpler explains.

The unit's unique staffing structure and service model may offer a blueprint for other rural hospitals. Jesus Ruiz, a family physician at the Chatham Maternity Care, told NC Health News, "Chatham is a template, but it’s not a copy-and-paste template. . . .This shows a way that rural maternity care can be built and sustained.”

UNC Health Chatham leaders are working to spread the success of their model. Crumper adds, "Eric Wolak, the chief operating officer at UNC Health Chatham, said he’s fielded calls from other community hospitals — within and outside the UNC Health system — asking about the family medicine-driven model and Chatham’s implementation."

Mobile health clinics are combating maternity care deserts in Florida

An OB/GYN mobile outreach clinic directed by researchers Adetola F. Louis-Jacques, Arielle Ayotte, and Michelle Nall at the University of Florida is helping to address a maternity care desert in north-central Florida, they report for The Conversation.

Nationwide, 2.5 million, or 4%, of American women of childbearing age live in a maternity care desert, they report. A maternity care desert is any county with no hospital, birthing center or obstetric health care professional. “Women in maternity care deserts travel an average of 35 miles to reach a birthing hospital, compared to an average of 9 miles for women in full-access counties.”

Traveling longer distances for obstetric care is directly correlated with poorer infant and maternal health outcomes, studies show.

Florida counties with full, low, or no access to maternity care. 
(Map via The Conversation CC, data from March of Dimes 2023 statistics, Click to enlarge)

In Florida, only three of the 14 north-central counties have full access to obstetric care, the researchers explain, and six have low access. The other five counties are deserts that they estimate to have 3,400 women of childbearing age. They also found in a 2024 report that 18 of Florida’s 21 rural hospitals have no more obstetric care, often because of a lack of funding.

Their new mobile clinic, started in February last year, offers prenatal and postpartum care, breastfeeding support, family planning, annual gynecological exams and preventive health screenings. They have already cared for 194 women in 616 visits.

Everything is free to the patients, and they offer assistance to help eligible patients apply for Medicaid benefits. “In 2023, about 1 in 7 women of childbearing age in Florida were uninsured,” they report.

A survey of mobile clinic patients across the U.S. found they “reported receiving holistic care, feeling safer than they’d felt in other health care settings and interacting with staff who were mindful of health care costs,” as well as being able to “maintain continuity of care.”

Most mobile clinics don’t offer maternal and infant health services, the researchers explain, and as maternity care deserts grow, more OB/GYN mobile health clinics like this one can directly provide low-income, rural areas with regular prenatal and postpartum care that women wouldn’t have access to otherwise.

Congress could change USPS finances and avoid more service cuts that disproportionately hurt rural areas

Rural residents are more dependent on 
the USPS. (Photo by A. Land, Unsplash)

The U.S. Postal Service can't borrow any more money to cover ongoing deficits, and unless changes to its funding are made, USPS leadership has warned that the service will run out of money sometime in 2026. Elena Patel reports for Brookings.  "This fiscal crisis reflects a structural mismatch between what Congress requires the Postal Service to do and how it is financed."

When the USPS was created, its financial foundations included a monopoly on letter delivery tied to a universal service mandate; however, as the number of letters mailed in the U.S. steadily declined beginning in 2007, the universal service requirement remained in place. The lack of letter revenue essentially meant USPS could no longer afford to deliver to all 169 million addresses that Congress mandated it serve with affordable rates.

Once letter revenue tanked, the USPS still delivered to every address despite the financial toll. "The USPS nationwide delivery network ensures that access does not depend on geography or profitability," Patel explains.

Brookings graph, from USPS Form 10-K Operating Statistics, FY 2007–2025.

For rural communities, USPS mail carriers often go the "last mile" to complete a delivery. The mail is a backbone for small-town businesses, finances and even medical care. Patel writes, "Particularly in low-density and rural communities, the mail remains essential infrastructure. It delivers prescription medications, ballots, and online purchases, and it supports local small-business activity."

Patel suggests some USPS changes that Congress could enact, which are edited for brevity below.

• Restructure pension liability finances, "including shifting these costs to the Treasury, as is done for other federal agencies."
• Pay universal service costs: "The cost of the universal service obligation exceeded the value of the postal monopoly by roughly $2-$3 billion per year for the last several years. . . . Congress could fund that mandate explicitly through annual appropriations."
• Increase the USPS borrowing cap and allocate funds for infrastructure improvements. "Additional capital flexibility could ease short-term liquidity pressures and allow USPS to finance modernization over time rather than from current cash flows."

Congress can "realign the financing framework with the universal service mandate it has imposed," Patel adds. "Or it can allow liquidity constraints to narrow that mandate by default. In practice, that 'default' path would likely involve deferred payments, delayed investment, and increased pressure for service cuts that fall most heavily on the communities most reliant on the mail."

Waves of American doctors and nurses leave their practices and head to Canada to avoid U.S. political climate

Often born and trained in the U.S., many nurses and doctors are leaving the U.S. for Canada.
(Graphic by Oona Zenda, KFF Health News)

At a time when Americans can least afford to lose medical professionals, many are leaving the U.S., citing the country's current political climate as their reason for leaving. In rural parts of the U.S., already facing a chronic shortage of medical care providers, the loss of any medical professionals makes accessing care more difficult.

"American nurses, doctors, and other health care workers moving to Canada, and specifically British Columbia, where more than 1,000 U.S.-trained nurses have been approved to work since April 2025," Brett Kelman of KFF Health News reports. 

Justin and Amy Miller from Wisconsin serve as one example. They are both nurses who were born in the U.S. and trained at American schools, but didn't want to stay in the U.S. because of policies and cuts by the Trump administration, Kelman explains. They moved their family of five to Canada, where they found new nursing jobs.

As the Trump administration systematically slashed "funding for public health, insurance, and medical research, many nurses have felt the draw of Canada’s progressive politics, friendly reputation, and universal health care system," Kelman reports.

For U.S.-trained nurses, Canada is rolling out the welcome wagon. "Ontario and British Columbia have streamlined the licensing process for American nurses since Trump returned to the White House," Kelman writes. British Columbia also launched a $5 million advertising campaign last year to recruit nurses from California, Oregon, and Washington state."

Doctors are leaving as well. "Michael, an emergency room doctor who was born, raised, and trained in the United States, packed up his family and got out," Kelman reports. KFF did not use his last name because he expressed concerns about reprisals if he returned to the U.S. 

Rural Canadians, who also struggle with accessing medical care, are also hoping to attract some American medical professionals. Doctors Manitoba, which "represents physicians in the rural province that struggles with one of Canada’s worst doctor shortages, launched a recruiting campaign after the election to capitalize on Trump and the rise of far-right politics in the U.S," Kelman writes. 

Opinion: Rural Americans rely on immigrant physicians for care, but new restrictions will leave them with fewer doctors

Rural hospitals have relied on foreign-born doctors
to provide care for decades. (MedPage Today photo)

Rural communities already struggle to staff their hospitals and clinics with physicians of all types, from specialists to family practitioners. The Trump administration's failure to make progress on immigration changes and the newly established $100,000 fee for each new H-1B visa application, which has no exemption for health care workers, will leave rural Americans with far fewer doctors to treat them, writes Manav Midha in his opinion for MedPage Today.

The difference in the number of physicians and the availability of specialists between urban and rural locations is stark. Midha writes, "There are approximately 263 specialists for every 100,000 people in urban areas compared to 30 for every 100,000 people in rural areas, and 46% of counties (and 86% of rural counties) have not a single cardiologist."

For decades, rural communities have relied on immigrant doctors for their care. Midha explains, "Foreign-born physicians are uniquely willing to serve rural communities even when few others move there. Immigration restrictions risk cutting off one of the last remaining lifelines for rural healthcare access."

Immigrant doctors who came to the U.S. in the 1980s and 1990s were able to obtain J-1 visas, which "allow for a path to permanent residency if a doctor works for at least 3 years in an area with underserved healthcare needs," Midha adds. They cared for patients in "rural Indiana, deep Appalachia, coastal Louisiana, and parts of Texas, hours from the closest city," where few American graduates wanted to live.

Congress could expand the Conrad 30 program to add some physicians with J-1 waivers who can treat in rural communities. "The bipartisan Conrad State 30 and Physician Access Reauthorization Act would have expanded (albeit slightly) the number of spots and extended the program. It was initially introduced in Congress in 2023 and again in 2025 but has seen little movement," Midha writes.

In the face of the current shortage, some states are developing their own approaches to help rural communities secure access to doctors. Midha writes, "At least 18 states, led by Tennessee, have enacted laws permitting internationally-trained physicians with appropriate experience to practice medicine without having to repeat medical residency."

Meanwhile, some rural communities may face a more severe shortage of physicians, and residents will have to travel longer distances for care. Expanding and developing paths for immigrant physicians "is not merely a moral imperative -- it is an economic one," Midha adds. "And it is one that can address one of the greatest challenges to equitable care."

Rural communities develop child care models that can be reshaped to fit a community's unique needs

Medicine Lodge Daycare shares its building with
four other childcare providers.

As rural parents and government officials partner to address child care provider shortages, new business models that allow would-be home or niche child care providers to operate in non-residential buildings are catching on, reports Anne Vilen of The Daily Yonder. The innovative approaches are providing jobs, child care spots and in some cases, reinvigorating rural downtown spaces. 

The story of LeyAnn Gehlen-Wampler of Medicine Lodge, Kansas, serves as an example. After the birth of her first child, Gehlen-Wampler couldn't find a child care provider. She was considering opening her own child care center when "she met Julie Warner, an early childhood consultant for the city who had once been a family childcare provider herself," Vilen explains.

Gehlen-Wampler and Warner, along with city administrators, smart design and construction professionals, and a mix of grant funding, helped create a "cluster of small, fully equipped childcare businesses in a main street building," Vilen reports. "Although Gehlen-Wampler's Medicine Lodge Daycare occupies a commercial space in the heart of downtown, the building was renovated into five separate rooms with separate entrances and outside playgrounds ideal for five independent family childcare providers."

The child care complex has helped the town's economy too. Medicine Lodge city councilman Matt Forsyth told the Yonder, “What it means for downtown is huge. It keeps Main Street alive in a small town where most main streets are dying."

Now known as the "plex" model, creating more modular child care centers outside of a residential home can't be done in all states. Vilen writes, "Kansas is one of just seven states (the others are Alaska, Missouri, Idaho, Mississippi, Nevada and Wisconsin) that allow family childcare providers to operate in non-residential settings such as schools, businesses, or hospitals."

Other rural areas are developing child care options similar to the complex structure but tailored to their specific needs. In Indiana, communities are participating in a "Micro-Facility Pilot program that launched in early 2025," Vilen adds. "Six existing child care centers applied to open smaller satellites in rural or small town libraries, schools, and shopping centers." 

Providers in Minnesota are experimenting with "child care pods," Vilen reports. "They allow children to bring their own lunches and snacks, support mixed-age groups, and draw on the resources of the larger micro-facility hub for staffing and administrative support."