Place matters in the United States. Access to affordable high-quality healthcare depends upon where you live. Throughout rural America, nearly 50 million people face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the healthcare disparities and access concerns that are already elevated in rural communities. High poverty rates and job loss in the current economic recession highlight the challenges of accessing health care and rising health care costs in rural areas. Rates of poverty are higher, with fifteen percent of people in rural areas living below the poverty level compared to twelve percent of people in urban areas. The rural economy is dominated by small businesses, which are struggling as the cost of healthcare continues to skyrocket. In the current recession, the rural economy is losing jobs at a faster rate than the rest of the nation, and loss of jobs can lead to loss of healthcare coverage. In particular, rural communities dependent on manufacturing have lost nearly five percent of their jobs since the recession began.

Many rural residents work part-time, seasonally, or for themselves, making them less likely to have private, employer-sponsored health care benefits. Research shows that ninety percent of farmers have insurance coverage; one-third purchased it directly through an insurance agent (compared to the national average of eight percent). Nearly one in five of the uninsured or 8.5 million people live in rural areas. This problem is worse for rural minority populations, the rural poor, and those with less than a high school education. Rural residents spend more on health care out-of-pocket expenses than urban