In this brief, Senior Demographer Kenneth Johnson reports nonmetropolitan (rural) America gained population between April of 2020 and July of 2022. In the preceding decade, rural areas lost population, both because more people left rural areas than moved to them and because births just minimally exceeded deaths. In contrast, the recent, modest rural population increase occurred because a significant net migration gain more than offset the growing excess of deaths over births fostered by the pandemic. That rural migration was strong enough to produce population growth is especially surprising given that deaths outnumbered births—in part due to the pandemic—in 85 percent of all rural counties.

Monitoring demographic trends informs planning for medical facilities, staffing, and access to specialized care, all issues that are important to the provision of rural care. Health needs are greater in areas with older populations and where pre-existing medical conditions are more prevalent. The rural population is older and has more pre-existing conditions than its urban counterparts. In addition, higher levels of poverty, inequality, and food insecurity among rural populations increase their health risks. Access to health care is also a significant challenge in rural areas where there are fewer practitioners and facilities providing care. In addition, timely access to comprehensive medical centers and specialized care is less available because of lower rural population density.

It is imperative that we continue to monitor rural demographic trends so that health care planners and providers can best position themselves to address the unique challenges of providing healthcare to the rural population.


Carsey School of Public Policy

Publication Date

Fall 11-16-2023


National Issue Brief No. 175


Durham, N.H. : Carsey School of Public Policy, University of New Hampshire

Document Type



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