Poll: Four in Ten Rural Americans Report Problems Paying for Medical Bills, Housing, or Food; Majority Optimistic About Having an Impact on Improving Their Communities

One in three rural Americans say homelessness is a problem in their local community.

    • May 21, 2019

Princeton, N.J.—According to a new NPR/Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health poll, although a majority of rural Americans are optimistic about having an impact on improving their local communities (62%), a small share are experiencing problems in areas that carry major consequences, including financial insecurity, trouble accessing affordable, quality health care, lack of high-speed internet access, housing, and isolation/loneliness.

Despite a growing national economy, four in ten rural Americans (40%) say their families have experienced problems affording medical bills, housing, or food in the past few years (see table below). A sizeable share of rural Americans face challenges with financial insecurity, as nearly half (49%) say they cannot afford to pay off an unexpected $1,000 expense right away.

This is the second poll in the Life in Rural America series, conducted among 1,405 adults living in the rural United States. This survey found the vast majority of rural Americans say their communities are safe from crime (88%, see figure below), and a majority (73%) are satisfied with their quality of life.  

However, many rural Americans continue to lack adequate health care access. Though most rural Americans have health insurance, about one-quarter (26%) have not been able to get health care when they needed it at some point in the past few years. Nearly one in ten rural adults (8%) say hospitals in their local community have closed down in the past few years.

“Even with major improvements in health insurance coverage over the last decade, it is concerning that one in four rural Americans are struggling to get the health care they need,” said Robert J. Blendon, co-director of the survey and the Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health.

Beyond health care, rural Americans are left unable to participate in the digital economy without reliable, broadband (high-speed) internet access. About one in five rural adults (21%) say accessing high-speed internet is a problem for their family. Among rural adults who use the internet, a majority say they do so to obtain health information (68%), for personal finance (61%), and for work-related activities (54%).

When it comes to homelessness and housing issues, one-third of rural Americans (33%) say homelessness is a problem in their local community, while more than one in ten have experienced several types of housing problems in their current residence, including the safety of their drinking water (17%) and mold or other environmental problems (16%).

In addition, while nearly one in five rural adults say they always or often feel isolated or lonely (18%), most report having at least a few people nearby they can rely on for help or support (92%).

“An important goal in funding this research is to help build a more complete understanding of the challenges to being healthy and the strengths of rural places in fostering good health,” said RWJF President and CEO Richard Besser.  “While it’s encouraging to see neighbors looking out for each other and strong networks of social support, it’s sobering to see that rural families struggle to pay for housing or food, go without needed medical care and lack financial security and essentials like high-speed internet access.”

This report also includes key findings among the following rural subgroups: adults living with disabilities, Black adults, Native American adults, adults living in mobile homes, and low-income adults. Key findings are also presented by education, age, and region.


Table. Rural Families Face Difficulties Paying for Medical Bills, Housing, Food
NPR RWJF Harvard Poll Chart


The poll in this study is part of an on-going series of surveys developed by researchers at the Harvard Opinion Research Program (HORP) at Harvard T.H. Chan School of Public Health in partnership with the Robert Wood Johnson Foundation and National Public Radio.  

ABOUT HARVARD T.H. Chan School of Public Health

Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.



NPR connects to audiences on the air, online, and in person. More than 26 million radio listeners tune in to NPR each week and more than 30 million unique visitors access NPR.org each month, making NPR one of the most trusted sources of news and insights on life and the arts. NPR shares compelling stories, audio and photos with millions of social media users on Facebook, Twitter, Instagram, Pinterest, YouTube and Snapchat; NPR News and NPR One apps, online streaming, podcasts, iTunes radio and connected car dashboards help meet audiences where they are. NPR's live events bring to the stage two-way conversations between NPR hosts and the audience in collaboration with the public radio Member Station community. This robust access to public service journalism makes NPR an indispensable resource in the media landscape.


About the Robert Wood Johnson Foundation

For more than 45 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are working alongside others to build a national Culture of Health that provides everyone in America a fair and just opportunity for health and well-being. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

Media Contacts

Jordan Reese

Robert Wood Johnson Foundation (609) 627-2233

Rural Health in America

This collection contains resources that focus on our nation’s rural health challenges and helping rural communities achieve better health for all.

Learn more