A Medicare pilot program will use artificial intelligence for prior authorizations. Doctors and lawmakers are alarmed.

Some prior authorization requests are already decided
by artificial intelligence. (Adobe Stock photo) 

A Medicare pilot program that allows private companies to use artificial intelligence to approve or deny medical care requested by their members has some doctors and lawmakers worried. Companies included in the pilot would get paid, "based on how much money they save Medicare by denying approvals," reports Anna Claire Vollers of Stateline.

The pilot, known as the Wasteful and Inappropriate Services Reduction (WISeR) Model, will launch after Jan. 1 in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. WISeR is more likely to impact health care treatments for rural Americans in those states because rural populations often skew older and sicker than their suburban and urban counterparts.

At its core, the WISeR model effectively introduces a prior authorization process into traditional Medicare. Prior authorization is already unpopular with many patients and doctors because it requires members or medical providers to request an insurance company's approval for certain treatments or medications before proceeding.

While some Medicare Advantage and private insurance companies have already deployed AI into some of their prior authorization processes, its use has "attracted intense criticism, legislative action by state and federal lawmakers, federal investigations and class-action lawsuits," Vollers explains. "It’s been linked to bad health outcomes. Dozens of states have passed legislation in recent years to regulate the practice."

The new program has "alarmed many physicians and advocates in the affected states," Vollers reports. In practice, the prior authorization process can create obstacles to care by requiring physicians to spend hours fighting with an insurance company to justify the care they believe their patient needs. At times, medical providers may avoid treatments that would be best because an insurance company is likely to deny them, at least initially.

Last month, congressional representatives from several states "introduced a bill to repeal the WISeR model. It’s currently in committee," Vollers reports. The program is scheduled to run from 2026 to 2031.

A small university town in southern Illinois 'leads the nation in out-of-state abortion patients'

Adobe Stock photo

Surrounded by farmland and the vast wooded expanses of the Shawnee National Forest, Carbondale, Illinois, has become a central hub for abortion access. 

The small-sized town, which is home to Southern Illinois University Carbondale, is within “driving distance of 10 states with abortion bans,” reports Elizabeth Williamson of The New York Times. “Last year, there were nearly 11,000 abortions in this city of 21,000.”

After the Supreme Court overturned Roe v. Wade, 14 states have banned the procedure. Those bans made “geography an all-important factor in access to the procedure,” Williamson explains. “And placed Carbondale, a liberal enclave in a deeply conservative region, in a complicated position.”

Unlike many of its neighboring states, abortion remains legal in Illinois. Carbondale's location near the southern tip of Illinois makes travel from states such as Missouri, Indiana, Kentucky, Mississippi and even Louisiana possible for women seeking the procedure. Williamson writes, “Illinois now leads the nation in out-of-state abortion patients.”

Although many Carbondale residents support “its status as a safe harbor. . . the sheer number of abortions has also created some unease and worry about a backlash,” Williamson explains. 

One community member told Williamson she was concerned about the negative attention the high number of abortions could bring to the otherwise “quiet community.”

Carbondale has three women’s clinics that perform abortions, but two of the three provide other women’s health services. “Alamo Women’s Clinic only does abortions, both procedural and medication, all on-site,” Williamson reports. “Fewer than five percent of Alamo patients are from Illinois.”

While details of rural health transformation requests aren't available yet, some states are sharing their information

KFF News RHTP tracking map as of Dec. 2. Click to enlarge.

The newly formed federal Rural Health Transformation Program has $50 billion to distribute to states that met its Nov. 5 application deadline; however, a complete picture of which states applied and what they asked for isn't clear because the Centers for Medicare & Medicaid Services have "declined to publicly release the applications," report Sarah Jane Tribble and Arielle Zionts of KFF Health News.

CMS said it isn't allowed to "release grant applications to the public during the merit review process,” KFF News reports. "They've pledged to announce the allocations by Dec. 31."

RHTP was passed as part of the One Big Beautiful Bill Act in July, which drastically cut Medicaid spending and will disproportionately impact rural areas. But RHTP can't be used to "bail out" rural hospitals or clinics. KFF News explains, "The money [must] be spent on transformational ideas."

Although CMS isn't sharing application details, some states have been transparent about their applications. According to the article, a health strategy team at Princeton University tasked with tracking state application summaries found "themes including expansion of home-based and mobile services, increased use of technology, and workforce development initiatives . . ."

KFF Health News is collecting state-by-state application materials and adding them to its mapped repository, which will be updated as information arrives. 

What's on your holiday table? Americans weigh in on Thanksgiving and Christmas meals.

When it comes to holiday traditions, many Americans see special foods and meals as part of the season's delights. Agriculture researchers at the University of Illinois wanted to know if the last few years of food cost increases, inflation woes and recent tariff wars in the U.S. have changed the way Americans set their holiday tables this year. Their lightly edited discoveries are shared below.

University of Illinois graph, data from the Gardner Food and Agricultural Policy Survey, Nov. 2025

Thanksgiving marks the first of several major feasts across the country. The main attraction? Food! More precisely, for many Americans, it means eating turkey. "Of those respondents who typically celebrate Thanksgiving with a meal, the most commonly reported protein source was turkey. A whopping 86.5% of those who celebrate Thanksgiving with a meal said they planned to serve turkey," Maria Kalaitzandonakes, Jonathan Coppess and Brenna Ellison write.

Christmas dinner fare has changed throughout American history; in fact, colonial Americans considered eating turkey a luxury, and many families opted for goose, duck or rabbit. Even with inflation and tariffs, 2025 offers more options for sumptuous Christmas meals. The researchers add, "Of those respondents who typically celebrate Christmas with a meal, turkey (47.9%), pork (47.5%), and beef (39.9%) were the most common protein sources. . . . 22.8% said they planned to serve fish or seafood, 11.1% said they planned to serve lamb."

University of Illinois graph, data from the Gardner Food and Agricultural Policy Survey, Nov. 2025

Of course, price matters: Sixty-nine percent of respondents said they expect food prices to affect their meal plans. Researchers asked consumers to share their strategies for reducing food costs. "The two most commonly reported strategies were shopping for deals on ingredients (45.5%) and shopping ahead of time to spread out ingredient costs (42.1%)."

A growing company pins its success on rural workers who have 'grit, grind. . . and aptitude.'

The Provalus website boasts about the company's commitment to "revitalizing historically underutilized business zones in rural downtown communities." (Provalus graphic)

Instead of outsourcing work to other countries, big-business service partner Provalus establishes offices in rural towns in the U.S., where it "finds people who are eager for jobs that will teach them 21st-century skills but who have few opportunities," reports Lauren Weber of The Wall Street Journal. The company's unusual playbook could become a "model for creating jobs in often-overlooked pockets of the country."

Provalus provides insurance-claims processing, cybersecurity, IT help desk coverage and other services to larger companies that need additional support. The company is intentionally expanding into rural America, where it works to identify potential employees with aptitude rather than requiring years of experience.

Chuck Ruggiero, the company's founder, told Weber, "There is an untapped labor market in rural America. They have the grit, the grind, and many have the aptitude."

The company's fourth location in Tahlequah, Oklahoma, which opened in 2022, is an example of an area that aligns with the niche demographics Provalus seeks out. Weber explains, "No major highways or railroads run through Tahlequah. The 16,000-person town in northeastern Oklahoma has a poverty rate of 20.3%. . . . The average individual income hovers around $30,000."

As an employer, Provalus competes with area retailers and restaurants for workers and pay usually starts around $13 to $14 per hour. But unlike many hourly jobs, the "wage potential at Provalus is high for some, and the benefits package is generous," Weber reports. "Health insurance costs $1 per paycheck. For the first six months, employees receive scheduled raises every 60 days."

Provalus clients such as Chick-fil-A and the Navy Federal Credit Union have signed up, at least in part, because they like the company's commitment to rural American workers. Weber adds, "They also reap the benefits of onshore services: Time zones line up, data is easier to protect, and site visits don’t require overnight flights."

U.S. sugar farmers take a beating as price per ton tanks

A truck unloads sugar beets. (Red River Valley Sugarbeet 
Growers Association photo)

U.S. soybean and corn farmers aren't the only ones taking a beating in this year's agriculture market. Sugar beet farmers will also see abysmal payments for their record 2025 crop, report Jenny Schlecht and Kjersti Maday of AgWeek.

American Crystal Sugar announced it will pay farmers $43.85 per ton for its record 2025 crop, a "far cry from the $78 it paid last year or the $83.18 it paid for the 2023 crop," Schlecht writes.

The Minnesota-based sugar cooperative explained the lower prices, saying "net sugarbeet payments per ton for 2025 will be far less than payments in recent years due to low sugar prices blamed on sugar dumping by companies that heavily subsidize their sugar crops," AgWeek reports.

Sugar beets are white-rooted.
 (Merriam-Webster drawing)

Sugar beet growers, like other American farmers, have faced high input costs for labor, fertilizer and machinery. They are also grappling with less demand. Demand is down about 4% from a high several years ago, according to the article. Inflation, shifts in the American and even changes in SNAP allowances can all be contributors to less demand.

But Tom Astrup, the president and CEO of American Crystal Sugar, said price worries are the "greatest threat to the sugar industry since Mexican sugar dumping more than a decade ago," Schlecht explains. "The industry has been 'hammered' by the imports of world sugar, which Astrup said the Department of Agriculture has lost control of. That, he said, has led to the highest stocks of sugar in the U.S. in 25 years."

Forever chemicals in drinking water are a national problem, but smaller communities face the biggest challenge

Minnesota lawmakers learn about technology to remove PFAS.
(Photo by Tad Johnson, Dakota Tribune)

The costs of removing forever chemicals, or PFAS, from municipal water could leave smaller communities behind. Most rural utilities don't have a PFAS contaminant filtration system, nor can they afford one, a 2025 study found. "Small, rural communities are the least likely to have the advanced systems in place," reports Brian Bienkowski for The New Lede.

The technology to remove the long-lasting, human-made "forever chemicals" found in many commercial and industrial products that have been linked to a range of health risks, including several types of cancer, fertility issues and developmental delays in children, can cost millions of dollars to purchase and install.

Even smaller cities are struggling to cover the costs to remove forever chemicals. In Apple Valley, Minnesota, some of the expenses utilities are paying to bring PFAS levels in their drinking water into compliance with Environmental Protection Agency rules will "likely hike water rates [customers pay] to fund a $100 million project to rid its wells of PFAS," reports Eva Herscowitz of the Minnesota Star Tribune.

To help buffer the costs, Apply Valley is asking its legislature to "include $40 million in the 2026 bonding bill for the project that would add membrane filter technology, which would increase the treatment plant’s capacity from 18 million gallons per day to 20 MGD," reports Tad Johnson of Thisweek Dakota County Tribune.

Like many rural areas with higher levels of PFAS contaminants, Apple Valley can't trace the source of its forever chemicals, which has allowed some communities to tap lawsuit dollars from companies such as 3M that were found responsible for tainting regional wells.

The Environmental Study Group found that "just 8% of U.S. water systems are equipped with filters that can remove PFAS. And 98% of systems that have PFAS detections do not have treatment targeting the chemicals."

Dan Hartnett, the chief policy officer at the Association of Metropolitan Water Agencies, cited a report that "estimated annual household cost to pay for the advanced treatment methods would average an additional $230 per household per year," Bienkowski writes. Hartnett added, “The numbers were significantly higher for the smallest water systems."

Even though more rural high schoolers graduate than their urban peers, fewer go on to college. Why?

Rural high school students might not have access to the same 
technology as their urban peers. (iStock photo via The Conversation CC)

In 2020, nearly 90% of rural high school students earned their diplomas, compared with 82% in urban areas. And yet, urban students remain more likely to attend college. Several factors, including a lack of college recruitment in rural areas, explain the disparity, writes Sheneka Williams, an education professor at Michigan State University, for The Conversation.

Being the first one to attend college is a tough choice -- especially if no one's encouraging students to consider it. "If these universities don’t know you exist, and if your parents haven’t gone to college and don’t know how the admission system works, you might not have help as you move closer to attending college," Williams explains. "Some rural schools also do not have college counselors."

Teacher shortages in STEM subjects are particularly tough for rural schools to overcome. Williams explains, "This lack of science course offerings can create a whole block of students who are not going to college."

Another educational drawback to living in more remote pockets of the U.S. is that it is more time-consuming and expensive for college recruiters to get students who might be considering college. Williams adds, "I think the narrative around rural students and college needs to shift – these students may want to go to college, but nobody is looking for them."

The STARS College Network is one group that has been successful in engaging rural students with colleges, but more outreach is needed.

What does it mean when cuts from the 'One Big Beautiful Bill Act' close a rural town's only health care clinic?

The OBBBA cuts billions in federal spending on rural
health care over the next 10 years. (Wikipedia photo)

After the only health care clinic in rural Churchville, Virginia, closed, residents in this 200-person community are struggling to adjust.

"Gone are the days of seniors walking down the road from their house to see the town doctor," reports Eva McKend of CNN News. "Augusta Medical Group cited the health care provisions in the One Big Beautiful Bill Act for closing the rural clinics in Churchville and two other locations."

Even when the clinic's closure means some residents have to drive an hour to Charlottesville to see doctors, community members are reluctant to say anything negative about President Trump or his signature OBBBA legislation.

Across from the town's coffee shop, and just a few feet away from the shuttered clinic, a bold banner waves with the words "Thank you, TRUMP, Save America Again."

Democrats are planning to make health care a "defining issue nationally in next year’s midterms," McKend writes. "But the environment in Churchville illustrates the challenges the party faces, particularly in rural communities."

Dale White, a Churchville resident and church administrator, says the "concerns about the clinic are overblown," McKend writes. White told her, "These are old-time rural farming folks, and they’ve been going to get medical care in Staunton and Fishersville, Waynesboro and Charlottesville since they can remember."

Many rural hospitals, clinics and providers that serve Medicaid patients were struggling to stay afloat before the OBBBA cuts. McKend reports, "The policy research organization KFF estimates that Trump’s bill will cut federal Medicaid spending in rural communities by $137 billion over the next decade."

A rural hospital in California closes after federal officials strip 'critical access' designation it has held since 2000

Glenn Medical Center in Willows, California 
(Glenn Medical Center photo)

After more than 70 years of serving its rural community in Willows, California, Glenn Medical Center closed its doors following the loss of its "critical access" designation, which had allowed the hospital to receive higher federal reimbursements that helped it remain open.

To qualify as a "critical access" hospital, a medical center needs to be at least 35 miles from the next closest hospital. Glenn Medical Center was 32 miles from "the nearest neighboring hospital under a route mapped by federal officials," reports Jessica Garrison of the L.A. Times. "Though that distance hasn’t changed, the federal government has now decided to enforce its rules." The hospital was awarded its critical access status in 2000.

The loss of Glenn Medical Center leaves the surrounding farming community without emergency care, "eliminates 150 jobs and puts rural residents at risk of preventable deaths," Garrison writes.

Rural hospitals across the state are already at risk of closure. Peggy Wheeler, vice president of policy of the California Hospital Association, told Garrison, "It’s like the beginning of a tidal wave. I’m concerned we will lose several rural hospitals, and then the whole system may be at risk.”

Before Glenn Medical Center's designation was stripped, Glenn County officials and hospital administrators worked for months to persuade federal officials to grant an exception.

Now that the hospital is closed, many community members fear what will happen to older residents in need of immediate care, injured farm workers or victims of car accidents along nearby Interstate 5. Glenn County Supervisor Monica Rossman told Garrison, "People are going to die."

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."

Democrats announce plan to 'win over voters in rural areas.'

It could take years for Democrats to see rural voter
 gains. (Adobe Stock photo)

In a bid to change its relationship with rural voters, the Democratic Congressional Campaign Committee announced a first-of-its-kind investment to "win over voters in rural areas — where the party has suffered deep losses in recent elections — in their effort to win a majority in the U.S. House of Representatives next year," reports Ashley Lopez of NPR.

Committee members see the U.S. economy as a topic they can use to engage Trump-supporting and leaning rural voters by showing that Democrats have something better to offer.

Suzan DelBene, who chairs the DCCC, told Lopez, "I think Republicans are turning their back. They've been actively hurting rural communities with the policies they've put in place."

Anthony Flaccavento, co-founder and executive director of the Rural Urban Bridge Initiative, said "economic frustration among most voters could provide an opening for Democrats, and that rural voters tend to align with economically populist policies," Lopez explains.

While Democrats plan their eight-figure investment to make inroads with rural American voters through targeted campaigns and staff focused on rural issues, it's impossible to predict whether they will be able to generate a meaningful shift in rural opinion in the near future.

Lopez reports, "Flaccavento said winning back at least a slice of those rural voters is likely to be 'hard as hell' for Democrats. But, he said, it's a problem the party needs to confront head-on." Flaccavento is pushing for Democrats to make long-term investments in rural races over the next decade, not just the next couple of election cycles. 

Opinion: Virtual cattle fencing offers a multiple-benefit solution for ranchers and helps migrating wildlife

Ranchers can easily move herd grazing lands with an app. 
(NoFence photo)

Western ranches in the United States include thousands of miles of barbed wire fencing, which has both positive and negative effects. GPS fencing could help ranchers strike a healthier balance while cutting business costs, writes Bruce M. Beehler in his opinion for The Washington Post.

Rangeland fencing is "an important tool for managing herds, rotating grazing areas, protecting environmentally sensitive wetlands and stream corridors, and keeping cows off highways," Beehler points out. "But it’s also harmful to wildlife populations, including deer, pronghorn, bighorn sheep and elk, as well as game birds such as the greater sage-grouse."

The idea behind GPS-based virtual fences is similar to "Invisible Fence," which uses buried wire to keep dogs in their yards. Similarly, virtual cattle fencing "uses GPS, cellular technology and a mapping app that allows ranchers to draw cow-proof fence lines on their computer or tablet," Beehler explains.

While the new system requires an initial investment in collars and cell service to install, Beehler believes it offers ranchers enough benefits to justify the initial price tag. For one, they won't have to repair nearly as much fencing, which is time-consuming and expensive for farmers and tax payers. 

For wildlife, removing barbed wire fencing from migration corridors will prevent animal suffering and death. Beehler adds, "One study in Montana found that, on average, one wild ungulate got tangled in fencing every 2.5 miles of fencing per year."

While the system is designed to keep herds within designated grazing lands, it offers a huge secondary benefit. Beehler writes, "With a glimpse at the mapping app, ranchers can see the exact location of every one of their cows in real time."

Virtual fencing collars could be replaced with ear tags.
(Photo by Chad Boyd via USDA)

Virtual fencing won't replace all physical fencing, "especially along highways and to keep bulls from wandering into a neighboring herd," Beehler explains. 

But for every mile of barbed wire that virtual fencing replaces "costs will decline. . . and as a result the annual cost of maintaining a herd will fall, increasing profit margins," Beehler adds.

The U.S. Department of Agriculture offers more insight on virtual fencing benefits for farmers, the environment and wildlife here. 

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?” 

Tyson Foods plans to shutter one of the country's biggest beef processing plants in rural Lexington, Nebraska

The Lexington plant could process 5,000 head of cattle
per day. (Tyson photo)

Even with national beef prices at historic highs, Tyson Foods was still losing millions from its massive processing plant in rural Lexington, Nebraska. To stem its losses, Tyson announced  plans to close the facility "at a time when a cattle shortage in the U.S. squeezes meatpacking companies," reports Patrick Thomas of The Wall Street Journal. 

U.S. Sen. Deb Fischer, R-Neb., a member of the Senate Agriculture Committee, "blasted the decision," reports Cindy Gonzalez of the Nebraska Examiner. Fischer told reporters, “As the single largest employer in Lexington, Tyson’s announcement will have a devastating impact on a truly wonderful community, the region and our state." The plant employs nearly 3,000 people, and the small town has roughly 10,300 people.

While Tyson is the biggest of the four meatpacking companies that process 85% of beef in the U.S., it will be the first "to close a major plant during the current cattle supply crunch," Thomas explains. "Meatpackers have been losing hundreds of millions of dollars processing beef because of the lowest amount of cattle on U.S. pastures since the 1950s."

The announcement comes after months of pressure from the Trump administration to lower beef prices for consumers. Thomas writes, "President Trump said earlier this month that the Justice Department was investigating the meatpacking companies for conspiring to drive up prices."

Tyson also announced it is "moving its Amarillo, Texas, beef plant that can slaughter about 6,000 cattle a day to a single shift, down from two shifts a day," Thomas adds. The Nebraska plant could slaughter nearly 5,000 cattle per day. Tyson's plant closure and Texas shift change could further tighten U.S. beef supplies and push grocery store beef prices higher.

A 'hyperscale' data center proposal divides a small town, but few details are known about the project

Residents pack a November meeting of the Bessemer City Council.
(Photo by Lee Hedgepeth, Inside Climate News)

A sprawling data center plan in Bessemer, Alabama, has divided the small town of 25,000 people, who know very few details about the project. 

Despite the lack of public knowledge about the build, the Bessemer City Council approved "rezoning hundreds of acres of forested land at the city’s edge to make way for a 4.5 million square foot data center," reports Lee Hedgepeth of Inside Climate News. Council members, some of whom signed nondisclosure agreements, voted 5-2 to allow the $14.5 billion project to move forward.

Two Bessemer City Council members, Cleo King and Donna Thigpen, "voted against the proposal, called 'Project Marvel,' which has been nearly universally opposed by the residents who live near the site," Hedgepeth writes.

King told Hedgepeth that he didn't think the Bessemer City residents stand to benefit anything from having "a data center [that will] include 18 buildings the size of Walmart Supercenters and consume a massive amount of water and electricity" move into their community.

Bessemer residents, both for and against the project, have attended city council meetings, with those opposing the build complaining that they receive only vague responses to their questions. Residents supporting the project say opponents are "anti-growth."

King said "even as a council member, he has not seen any additional planning documents answering the questions raised by residents and environmental groups," Hedgepeth writes.

"Several representatives of the local school system have testified in favor of the data center proposal," Hedgepeth reports. The developer behind the project reassured council members that Project Marvel will be a "financial boon for Bessemer and will cause no negative impacts for either residents or the environment."

It's hard for Bessemer residents on both sides to get the full measure of the proposal. Ryan Anderson, a staff attorney for the Southern Environmental Law Center, an environmental nonprofit, said that "she was shocked by how little is still publicly known about the project after months of public hearings," Hedgepeth reports. She told him, "You can’t answer the most basic questions about what company is building a data center here."

Report: Rural primary care physician shortages will persist for at least another 12 years

Graph by Celli Horstman and Arnav Shah, State of Rural Primary Care in the United States, Commonwealth Fund

Rural residents will continue to grapple with a shortage of primary care doctors for at least another 12 years, according to a report issued last week by the nonprofit Commonwealth Fund.

Using federal health workforce data, researchers concluded that "rural areas will continue to have only about two-thirds of the primary care physicians they need," reports Nada Hassanein for the Wisconsin Examiner. Report authors noted that the persistent shortage of primary care doctors leaves million of rural residents "with fewer options for routine and preventive care."

The report's release came just days after the window closed for hospitals to apply for a share of the $50 billion federal Rural Health Transformation Program administered by the Centers for Medicare & Medicaid Services. Hassanein writes, "Some states want to use the federal money to expand their rural residency programs, as physicians who complete their residencies in rural areas are more likely to practice in one."

Nearly all of the more than 40 million rural Americans live in areas with primary care physician shortages, according to the report. "Forty-five percent of rural counties had five or fewer primary care doctors in 2023," Hassanein adds. "Roughly 200 rural counties lacked one altogether."

The report found that doctor shortages in rural areas vary by region. Hassanein writes, "States in the South had 3,411 patients per physician, whereas states in the Northeast had 1,979 residents per physician."

Although rural areas will continue to lack enough primary care physicians, some of the gap will be filled by rural nurse practitioners. Hassanein adds, "Nurse practitioners are the fastest-growing type of clinician in the U.S., regardless of geography, the report authors wrote."

Debunking rural myths and misunderstandings

Photo by John Warg, Unsplash

Rural America makes up most of the United States’ land area and is a significant contributor to its economy. “Yet, in a nation with a mostly urban population, the challenges faced by rural people and places are often overlooked or misunderstood,” Tim Slack reported for GROW magazine.

Slack debunked five myths about rural areas that are pervasive among non-rural Americans.

Myth 1: In the context of urbanization, rural America is fading away due to population loss. “Paradoxically, the very definition of ‘rural’ puts limits on growth,” Slack wrote. Many rural areas are experiencing growth, however as the population gets bigger, those areas become reclassified as urban.

Myth 2: Rural is synonymous with farming. 
“Agriculture does constitute a greater share of employment in rural areas compared to urban areas,” Slack reported. But agriculture makes up only around 5% of employment in rural counties. Manufacturing is another major industry in rural areas. 

Myth 3: Rural America is not racially diverse. 
“In 2020, about one in four people (24%) living in rural America were non-White, with Hispanic (9%) and Black (8%) people representing the two largest groups,” Slack wrote. Indigenous people also live in rural areas.

Myth 4: Rural America is healthier. 
“Rural working-age mortality rates are higher for cancer, heart disease, Covid-19, transport accidents, suicide, alcohol misuse, diabetes, stroke, and problems related to or aggravated by pregnancy,” Slack reported.

Myth 5: A “rural revolt” propelled the presidential elections of Donald Trump. 
“While Trump has performed well with rural voters, doing so is consistent with a 50-year trend,” Slack wrote. Meanwhile, the drop in voter turnout happened in big cities with Kamala Harris receiving “roughly 8 million fewer votes than Joe Biden had four years before.”

Opinion: Rural kids need more than trade school training to lift themselves out of hopeless circumstances

Working-class rural kids need more than trade school training to help pull themselves out of unhealthy living situations, including abject poverty, writes Jessica Grose in her opinion for The New York Times.

Grose cites the new book by Beth Macy, Paper Girl: A Memoir of Home and Family in a Fractured America, as a source for insight and solutions on how the U.S. education system could help more rural youth recover from trauma and set their lives on a different track.

"Macy, a former newspaper reporter and the author of 'Dopesick,' the 2018 best seller about how the opioid crisis ravaged Appalachia, returned to her hometown, Urbana, Ohio, for the new book," Grose explains. "She is trying to figure out how a working-class girl like her got to college and the middle class from Urbana 40 years ago, while that journey is much more arduous for today’s rural working class."

"How do young people, especially those without supportive parents, make a future for themselves? . . . While learning a trade is excellent advice for many students, it is not the cure-all for inequality that our commerce secretary, Howard Lutnick, hopes it might be when he says he wants Harvard to build vocational schools,'" Grose explains.

Grose points out that "learning a trade" isn't easy and that trade work requires "the same kinds of executive functioning, people skills and intelligence that a college education requires, just applied differently."

Giving working-class youth the help they need through rural schools is one of the best solutions, according to Macy. "Rural schools need better access to wraparound services, providing students with necessities like food, but also health care in the form of school nurses and counselors on site," Grose adds.

But providing those types of services in rural areas is a tall order. Grose writes, "Most school systems run on economies of scale and a per-student funding model; it poses a great challenge to provide wraparound services to districts with fewer students who have a lot of needs and who are also spread out."

"My dark prediction is that kids with more stable families and better developed life skills will occupy the trade jobs that used to be a reliable route to the middle class," Grose asserts. "We need to support working-class kids before the 21st century abandons them completely."

Quick hits: Dairy farming with a robot; CSA debate; Farmers' Almanac ends; rural hospital success; goodbye penny

A robotic milker takes the place of a hired hand as dairy
farmers face labor shortages. (Farm Progress photo)

Marlane Williams always dreamed of owning her own farm and milking her own dairy cows. Now she has both, along with a robot that helps out while she's at a day job that provides income stability. "Williams has held several jobs while trying to be a dairy farmer," reports Chris Six of Farm Progress. "She's owned a dairy farm in southwest Missouri since 2002 and says balancing both is tricky, but she feels blessed to have achieved her dream." Instead of trying to hire part-time labor, Williams purchased a Lely Astronaut milking robot to make sure her growing herd is milked twice a day.  

The debate over whether the Community Supported Agriculture model is dead or alive continues, with a fresh perspective from Ruth Katcher, who runs a thriving CSA for city folk in Brooklyn, New York. "I’ve been mulling over Lauren David’s thought-provoking article on whether we’ve outgrown the CSA model," Katcher writes for Offrange. "I have to admit she made some excellent points, especially about the appeal of models that offer more choice to consumers than traditional CSAs. . . . But the traditional CSA model has features I would hate to give up . . ." Read Lauren's essay here, and Katcher's full counter here.

Pecan trees don't have to be planted every year. 
(Photo by Elizabeth Hewitt, Reasons To Be Cheerful)

In a drastic turn from traditional row-crop agriculture, some Midwestern farmers are planting nut trees that are reviving soil depleted by corn and soybean plantings. "In 2017, Josh Payne planted 20 acres of chestnut saplings, growing commodity crops in wide rows between the trees," reports Elizabeth Hewitt for Reasons To Be Cheerful. "Payne is among a growing number of farmers looking to supplement or even replace common crops planted annually — like corn and soy — with various types of nut trees. . . which can provide a type of multi-generational resilience because they can generate income for decades."

U.S. Mint photos

The U.S. Treasury Department laid the U.S. penny to rest on Nov. 12 in Philadelphia after producing it for 232 years. Victor Mather of The New York Times reports, "Top Treasury officials were on hand for its final journey. No last words were recorded. The cost to mint the penny had risen to more than 3 cents, a financial absurdity that doomed the coin. The American penny was preceded in death by its smaller sibling, the half cent (1793-1857), and its cousin, the Canadian penny (1858-2012)."

Internal medicine residents at Billings Clinic 
in Montana. (Photo by Colton Adams via the Yonder) 

A community hospital in Billings, Montana, is bucking trends with its successful medical residency programs, which train new doctors who often decide to stay in the state and practice. "As rural areas across the country face worsening provider shortages and reductions in health care services, Billings Clinic is celebrating the success of two new residency programs training," reports Madeline de Figueiredo for The Daily Yonder. "Since launching its internal medicine residency program in 2014, Billings Clinic has graduated 75 physicians, with half now practicing in rural communities. The program’s outcomes stand out amid national trends, where only 11% of physicians work in rural areas."

After more than two centuries of publication, the Farmers' Almanac from Maine announced that 2026 is its last print run. "The 208-year-old, Maine-based publication that farmers, gardeners and others have relied on for planting guidance and weather predictions will publish for the final time," report Patrick Whittle and Kathy McCormack of The Associated Press. "The Farmers’ Almanac, not to be confused with its older, longtime competitor, The Old Farmer’s Almanac in neighboring New Hampshire. . . . The almanac cited the growing financial challenges of producing and distributing the book in today’s 'chaotic media environment.'" The first Farmers' Almanac was published in 1818.