Life in Rural America

Experiences and views from rural America on economic and health issues and life in rural communities.

A teenager works behind a counter in a country store.

In rural communities across America, feelings of optimism for the future are tempered by concerns about opioid addiction and economic challenges.


While economic challenges in rural America have received significant national attention, a survey by NPR, the Harvard T. H. Chan School of Public Health and the Robert Wood Johnson Foundation finds that residents of rural communities consider drug addiction or abuse and economic issues as the biggest problems facing rural communities.

“Life in Rural America” illustrates that rural Americans have strong ties to local communities and value life, family, and jobs in rural America. On one level, rural Americans express concern about challenges facing local communities, such as money/financial problems, health and health care, and in particular, drug addiction/abuse and troubled local economies. At the same time, residents also report numerous reasons for valuing life in rural communities, and a majority report feelings of attachment to their local communities.

Key Findings

  • A majority of rural residents agree opioid addiction is a serious problem in their community (57%), with about half personally knowing someone who has struggled with opioid addiction (49%).

  • Almost one-quarter of rural adults (23%) say that drug addiction or abuse is the most urgent health problem currently facing their community, followed by cancer (12%) and access to care (11%).

  • Sixty-four percent of respondents say better long-term job creation would be most helpful to their local economy; 61% believe improving quality of local schools; 55% report improving access to health care; and 51% view advanced job training or skills as recommended approaches.

  • Fifty-two percent of respondents say they are active in solving problems in their local community, with younger adults reporting higher levels of participation.

  • Eighty-one percent of respondents report feeling attached to their local community, and 67% say neighbors have helped them in times of need.

The purpose of the "Life in Rural America" survey was to better understand the views and experiences of rural Americans on economic and health issues in their local communities. 

Split views on rural life and livelihoods

Most respondents in rural America are optimistic, saying their lives have turned out as expected (42%) or better than expected (41%). They report high job satisfaction (93%), including 59 percent who are very satisfied. But to keep jobs or find a better job in the future, a significant share (34%) of rural Americans believe it will be important to get new training or skills—including computer and technical skills (25%) or a more advanced degree or certificate (24%). This may be due in part to a significant number of young people having left rural America (according to 43% of parents), mostly for job opportunities elsewhere (61% to cities). In contrast to positive personal employment experiences, about half of rural Americans (55%) rate their local economy as fair or poor. Over the past five years, about a third of rural Americans say that the economy in the region where they live and work has gotten better, compared to those who say it has gotten worse (21%).

Rural community values and outlooks for the future

Most respondents say their community’s biggest strengths are: feeling attached to their local community (81% feel very or somewhat attached); relationships with neighbors (50%); life in a small town (21%); and being around good people (11%). When asked about the most important reason they choose to live in their local community, about one-third of rural adults say it is because of their family.

Rural Americans are largely optimistic about the future, as most say the number of good jobs in their local community will stay the same or increase in the next five years. About half of rural Americans (51%) report confidence that major problems facing their communities will be solved in the next five years. 


Overall, the "Life in Rural America" survey illustrates that rural Americans have strong ties to their local communities and value life, family, and jobs. However, rural Americans also cite significant challenges for their local communities, such as money/financial problems (27%) and health and health care (16%) challenges. They cite drug addiction/abuse (25%) and improving troubled local economies (21%) as the top problems they will face in the future. While rural Americans are confident that major problems facing their local communities can be solved within the next five years, a majority say they need outside help to solve these problems. 

About the survey

In summer 2018, researchers interviewed 1,300 rural adults age 18 years and older living in the rural United States. The sampling of respondents contains, by U.S region: South (42%), Midwest (32%), Appalachia (19%); by race/ethnicity: white (78%), black (8%), Latino (8%), with other race/ethnicities not statistically significant; by age: 50+ years old (55%) and 18–49 years old (44%).

The forum

Experts Discuss the Issues of Life in Rural America

On November 9, 2018, an online Forum at Harvard School of Public Health brought together a panel of experts to discuss findings from the 2018 Life in America survey conducted in collaboration with NPR and RWJF.

Watch the webcast