Rural communities are home to more people over the age of 65 than urban communities (see Figure 1), and studies show that the share of older adults may continue to grow in the next few decades. An analysis by the Urban Institute suggests that by 2040, 25% of households will be 65 years or older in rural communities, compared to only 20% in urban areas. As more older adults continue to live in rural places, active transportation, and transit options can allow more older Americans to maintain their independence without relying on a personal vehicle.

Rural counties also have higher proportions of people with disabilities. According to the CDC, about one in three adults in rural communities live with a disability, compared to one in four in the US overall.

As the decades have passed, communities once classified as rural have graduated to urban areas as their populations and local economies grew. Successive US Census efforts have reclassified many of these locations as urban over the decades, despite these communities often having more in common with rural places than with cities. Due to the reclassifications, the 2020 Census showed a population loss for rural areas, hitting an all-time low of 14% of the total US population. Of those areas still classified as rural in the 2020 Census, some are growing and thriving, but many others are disadvantaged and experiencing a population decrease.

These communities are often characterized by a history of waning industry such as mining, logging, farming, nuclear, or other resource-based activities. When these industries decrease, the population and economy lost are difficult to recover. Rural areas in decrease appear to be concentrated in the Great Plains, Appalachia, the Deep South, and other areas where little replacement industry has developed. Conversely, rural areas in the Mountain West, West, and other recreation-oriented areas nationwide have grown and thrived.

Still, numerous rural communities throughout the country have shown that they can diversify their job base, attract new residents, and thrive once more.

The global COVID-19 pandemic has also had an immediate impact that appears to have at least initially reversed the overall rural decrease shown in the 2020 Census. According to the Census Bureau, between April 2020 and July 2021, the US rural population grew by 77,000 people. While this is encouraging on the whole, the majority of this gain is attributed to migration into high-amenity recreational (gateway) and retirement, second-home rural communities. Rural areas without these amenities continue to lose population. It is still too early to tell if this trend will continue or revert to previous trends over time.

There is a relatively common assumption that rural communities enjoy a healthier living environment than urban areas. Rural America is often portrayed as having fresher air, fresher food, and nearby access to the natural environment for recreational and physical activities. While these can be true in some rural communities and small towns, those factors don’t necessarily make rural Americans healthier than their urban counterparts.

Access to healthcare

Accessing health care can be difficult because, on average, rural residents have lower incomes and lower rates of health insurance compared with their urban counterparts, and they live farther away from health care resources. In 2017, on average, US residents traveled 9.9 miles one way for medical/dental care, but rural residents traveled more than twice the distance for care than urban residents—8.1 miles for urban residents and 17.8 miles for rural residents.

Rural Americans are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts. Access to health care or emergency services can be the difference between life and death. Longer travel distances may mean more people skip preventative care like routine cancer screenings that can help address risks before they become more dangerous.

Between 2005 and 2014, nearly 200 rural hospitals across the nation closed, and the financial viability of remaining rural facilities is of ongoing concern. This makes getting to a health center for a job (the largest national employment sector with 20 million employees nationwide) or for medical care an increasingly longer trip.

This reduction in services and lack of convenient access to them doesn’t impact all rural residents equally. There are significant disparities by race and income level. For example, at the peak of the Omicron wave during the COVID-19 pandemic, the virus killed Black Americans in rural areas at a rate roughly 34% higher than white Americans.

Obesity

It has been estimated that the prevalence of obesity is approximately 6.2 times higher in rural than in urban America.¹ The growing prevalence of obesity in rural communities makes improving opportunities for daily physical activity through active transportation a key opportunity to increase physical activity as well as access to healthy foods—two components found in the built environment that influence obesity (see Figure 2).

Rural residents are less likely to meet federal physical activity guidelines. In 2017, only one in four (25.3%) urban residents and one in five (19.6%) rural residents met the combined aerobic and muscle-strengthening physical activity guidelines. According to the 2016–2017 National Health Interview Survey, 17.9% of rural Black adults met physical activity guidelines, compared with 27.8% of urban white adults. Regionally, states in the South (27.5%) had the highest prevalence of physical inactivity, followed by the Midwest (25.2%), Northeast (24.7%), and West (21.0%). Rural areas may lack access to the types of places and infrastructure that encourage residents to walk and be active, like parks and sidewalks.²

Additionally, the obesity rate for rural children ages 2 to 18 is 22%, compared to 17% for urban children. Transportation options for children, especially school buses, vans, and ride-shares scheduled for students in after-school activities, can potentially expand opportunities for rural children living in remote areas to take advantage of after-school physical activity programs.

Other health concerns

According to the CDC, rural Americans tend to have higher rates of cigarette smoking and high blood pressure, report less leisure-time physical activity, and lower seat belt use. Unintentional injury deaths are also 50% higher in rural areas than in urban areas, partly due to greater risk of death from motor vehicle crashes. When it comes to some of these disparities, increasing access to physical activity in rural areas would help create a built environment that would encourage daily physical activity.

Tribal and Native American communities face particular challenges to overall community health as a result of disruptions to traditional ways of life, loss of land, and government policies that have resulted in historical trauma. These factors contribute to higher rates of chronic disease and underlying risk factors, such as obesity and tobacco use.

While rural communities play a major role in the country’s food production, unfortunately, they experience overwhelming levels of food insecurity and hunger with 87% of the nation’s food-insecure counties being rural. These areas are called “food deserts” (i.e., areas with limited access to fresh, affordable foods). Many rural areas don’t have a population base large enough to support a grocery store that stocks a variety of affordable and healthy food, but limited transportation connectivity also makes it a requirement to own a car or personal vehicle to get to the nearest town to access healthier food options adding financial burden.

Long car trips aren’t a part of daily life for all rural residents. More than 1 million rural American households without cars face unique barriers as alternate modes are not always accessible or affordable. And for households with cars, research from Transportation for America and Third Way finds that households in rural areas and urban areas alike are driving significantly farther per trip on average as of 2017 than they were in 2001 to accomplish their commutes and daily tasks, 12 percent and 10 percent farther, respectively. Trip distances have increased across all types of trip destinations, especially for work and shopping. Most people wouldn’t choose to drive farther than they did a decade ago for the same basic trips, but development patterns in much of the country, and some loss of services in rural communities are driving this trend. And while these trends look similar across rural and urban areas, longer trips have the potential to create much greater burdens on rural Americans, negatively impacting their economic opportunities, quality of life, and healthcare access.

Many rural communities today are heavily reliant on just a few employers and medical facilities that serve a large share of the dispersed population. If any of those employers and institutions consolidate, close, or relocate farther from housing, residents may not have any other options, forcing them to take longer and more costly trips at best, or lose access to that work or service altogether.

Small and rural towns have great potential for creating viable networks that serve residents and visitors. In many rural communities, residents live long distances from services, but most small towns provide a compact center well-suited for walking and bicycling trips. Households closer to development in both rural and urban areas have much shorter daily trips than households located further from concentrated development (see Figure 3).

The presumption that living in a rural area inevitably means being dependent on a personal vehicle and driving long distances to access essential services negates the identities, experiences, needs, and inconveniences of the people in these complex and diverse communities. It also negates the opportunity to think creatively and holistically about ways to improve mobility for all residents. As stated previously, more than 1 million households in predominantly rural counties do not own a personal vehicle. Rural non-drivers—including older adults, low-income individuals, school-aged children, and people with disabilities—need independent mobility options to take advantage of social and economic opportunities.

While transit is sometimes perceived as a solution available only for urban areas, there is demand and capacity for it in rural areas. With the right design, planning, and community input, it can be a feasible and affordable option that addresses mobility needs while creating economic opportunities, including:

• According to a report by the Victoria Transport Policy Institute, rural area and small-town public transit services typically cost $20 to $40 annually per capita, which is lower than national per capita transit spending.
• Investment in public transportation boosts both the local and the national economy. Public dollars devoted to making capital improvements to public transportation systems support thousands of manufacturing jobs, in communities small and large, in nearly every state across the country.
• In reviewing data from 2000 to 2005, the American Public Transportation Association (APTA) found that nearly 9% of public transportation trips were for medical purposes in areas with populations less than 200,000.
• As reported in the National Transit Database (NTD), 1,301 agencies provided transit service in 2018. Many rural transit agencies (1,136) offer strictly an on-demand service, while 339 offer both on-demand and fixed-route service and some (468) offer just fixed-route service.
• Transit services are a particularly high priority on reservations and tribal communities as the population exists in low densities, travels long distances, and has a higher percentage of low-income households. According to the American Community Survey (ACS), 25% of reservations experience a poverty rate of 35% or higher.

Rural residents without cars face unique barriers as alternate options are not always accessible and affordable. A 2004 study found that older adults who no longer drive make 1% fewer trips to the doctor, 59% fewer trips to shop or eat out, and 65% fewer trips to visit friends and family, than drivers of the same age. As the importance of community livability for people of all ages becomes more evident, it’s critical for elected officials, local leaders, businesses, and nonprofits to understand the issues, challenges, and opportunities facing rural communities. Aging in the home where a person lived comfortably for years can be difficult when distance or a lack of transportation is a barrier to needed services. Distance isolates people who no longer drive.

Another common assumption about people living in rural areas is that they have better access to natural areas and other recreational destinations, including national parks, state parks, and other public lands. In many cases, this is technically true. For example, the majority of the 63 national parks in the United States are not located within urban boundaries. But access isn’t just about proximity to nature—residents also need to be able to affordably reach local parks and green spaces.

With limited transit access, these parks are difficult to access for those who do not own a personal vehicle or can’t drive. People trying to reach parks and recreational areas from adjacent communities without a car are often required to walk, bike, and roll along high-speed roads with no separation from vehicles. In fact, even when within national recreation areas, motor vehicle crashes are the second-leading cause of death.

“A lot of people in Montana don’t think twice about taking their car and driving three hours to go camping for the weekend. And in fact, that’s part of the lifestyle… This not only has accessibility issues for those who do not own a car, but also has significant environmental consequences due to increased air pollution amongst various other impacts. – Matt Parsons, Trails Director, GVLT – Bozeman, Montana

In 2019, the National Parks Conservation Association estimated that 96% of National Park Service-owned sites struggled with “significant air pollution problems” caused largely by private motorists, despite the fact that many are located in remote areas with few drivers besides park visitors. It also reported that 33 of America’s most-visited national parks are as polluted as the 20 largest cities. National parks, forests, wildlife refuges, and the Bureau of Land Management (BLM) lands, State and County parks, and other forms of public lands play important roles in the economies of many rural communities and small towns across America. Improved walking and bicycling access to public lands can also provide opportunities for physical activity in communities.

The National Park Service is increasingly focusing on expanding transit systems and providing alternative transportation options to reduce fossil fuel consumption and greenhouse gas emissions. Multimodal infrastructure improvements such as greenways, trails, shared-use paths, accessibility enhancements, and trails combined with additional interventions, community engagement, programming, and wayfinding contribute to connectivity, increased physical activity, and infrastructure use. Many rural communities are located near public lands that serve as popular destinations. Creating options to access these places through various modes of transportation in an affordable and comfortable way, in effect, extends these public lands into their surrounding communities.

Rural communities need thoughtful land development policies that encourage compact development and reinvest in more traditional patterns such as town centers rather than strip malls along highways on the periphery of communities. Over the past 40 years, research has shown that low-density, unconnected development is more costly to the public and local governments than compact development, like a small walkable downtown core. Every city and town considering new development should understand the financial impacts of where that development is located. In rural communities, it can be tempting to see any new development as a positive force, but development on the low-density outskirts of communities can make it harder for people to access daily needs without a car while undermining the long-term resilience of the community’s economy in the process.

These investments are important to support economic growth and keep working-age populations in rural and small-town communities. For example, “prime-age workers”³ continue to be the highest proportion of the labor force. They continue to show that they prefer to live in walkable communities with multimodal transportation options that don’t require them to drive to get to all of their daily needs and activities, whether in urban cities or rural small towns.

Younger generations also tend to make decisions about where to live based on lifestyle preferences, not jobs. Therefore, it is important for communities including rural and small towns to invest in creating great places to live if they want to attract and retain these members of the workforce. The National Association of Realtors showed that millennials more than any other generation prefer walking to driving. But survey respondents overall reported that they drive because they don’t have other options.

The past several decades have seen rural main streets change as local businesses have closed, to be replaced by larger chains spread out on external highways, often inaccessible by active transportation. Research has shown that low-density, unconnected development is more costly to the public and local governments than compact development, like a small walkable downtown core. Many rural communities have found success by reinvesting in their downtowns and main streets and rediscovering their sense of place. Revitalizing these historic town centers can also create resilient economies and also makes it easier for people to live closer to work, groceries, health care, dining, and shopping, allowing them to walk or bike to these daily destinations. To be most successful, these revitalization efforts also need to be paired with improved systems for active travel.

Downtown revitalization efforts can have economic benefits for local governments, especially in small towns and rural communities where tax bases have shrunk, infrastructure has deteriorated, and service needs are growing. Every city and town considering new development should understand the financial impacts of where that development is located. In rural communities, it can be tempting to see any new development as a positive force, but development on the low-density outskirts of communities can make it harder for people to access daily needs without a car while undermining the long-term resilience of the community’s economy in the process. It is important to critically evaluate potential development. How much will it cost to support that new development in the coming years? Would the development bring more net revenue if designed differently? A wide body of research has also confirmed that compact, walkable environments enjoy significant value premiums, or value per square footage of real estate, of 20% and higher, over sprawl. Zoning reform such as through Form-based Codes can be policy solutions to help guide productive investments in the community. For example, form-based codes create people-oriented communities with an emphasis on providing a variety of person-oriented options such as biking, walking, and gathering spaces; by focusing on the design of streetscapes, and the quality of open spaces and facades versus conventional zoning which focuses on the separation of uses and arbitrary design standards that leads to auto-dependant development. Form-based Code zoning can help foster more equitable development by offering a wider array of tools than conventional zoning does.

Rural cores should support walking and biking on main commercial corridors and main streets. As the street transitions out of the core area, the facility design that accommodates people walking and biking should change. Requirements for amenities such as sidewalks, landscaping, benches, art, bicycle parking, crossings, lighting, or awnings promote a human-scale frontage that welcomes active transportation.

In communities where destinations are far apart, pedestrian-oriented design can encourage a shift from auto-oriented development to spaces where community members have the option to walk. Adding pedestrian-oriented design features can strengthen a community’s sense of place and support sustainable economic, environmental, and social conditions that contribute to healthy, walkable places.

Development of regulations through zoning can support community investment. Such policies ensure that new buildings are accessible to the sidewalk and not surrounded by parking. Development may rely on street parking or locate parking on the side or behind the building. This would also help build a sense of place and character on the street that is likely to feel more inviting for people to walk, bike, and roll.

“Downtown has been reborn as a cultural, entertainment, professional, and retail hub, much like its glory days when the town center was the heartbeat of the city.” – Mayor Ronny Walker’

It is equally important to invest and use strategies that support connected, dense, walkable, and bikeable neighborhoods in rural areas and small towns. Low-density development makes the provision of critical services such as utilities, streets, sidewalks, and emergency services inefficient and more costly per resident. Additionally, communities with good street connectivity offer multiple options to reach nearby destinations and provide options for travel that may not require the user to travel along busier roadways. New development should include pedestrian and bicycling connections to adjacent neighborhoods and major streets, even if street connectivity cannot be achieved. Neighborhoods with few access points isolate residents and increase travel distances.

Activity-friendly routes to everyday destinations play an important role in rural communities: they connect all the amenities that make rural places unique. Whether it be a shared-use path to a work site, a bus stop to a park, or walkable dining and shopping in the town square, activity-friendly routes can help people move safely, and connect to the excellent natural landscapes, attractions, and sense of community that rural places have to offer. They may be smaller than urban neighborhoods, but rural communities can be equally connected and just as vibrant and walkable. Many rural communities around the US have sidewalk, bike, or trail systems that contribute to a higher quality of life for residents. Some communities have networks residents can use to reach necessities such as schools, grocery stores, health care, entertainment, and jobs, while some are suitable for recreational use only. Studies show⁴ that people in rural areas are just as likely to walk to places for leisure and transportation as those located in urban areas if the options are safe and accessible. Active transportation networks, in addition to providing transportation options, can also provide a solution to combat obesity and other chronic health diseases.

According to a recent study, there are 292 counties in the US where at least 10% of households don’t have access to a car (out of 3,142 total counties nationwide). Of those 292 counties, 56% are majority rural. These 164 rural counties are primarily located in Kentucky, West Virginia, South Dakota, Arkansas, North and South Carolina, Georgia, Alabama, Louisiana, Mississippi, and Alaska. Seven of these states made it into the top 20 states with the highest number of pedestrian deaths according to Dangerous by Design 2022: South Carolina (3), Louisiana (6), Mississippi (7), Georgia (9), Alabama (11), North Carolina (14), Arkansas (18).

Without robust active transportation networks, people walking, biking, and rolling in rural areas face unique dangers since rural roads are less likely to be designed with these uses in mind. They often lack sidewalks, bike lanes, shoulders, curb ramps, and safe options to cross the street, which leads to increased risk of traffic crashes.

People using active modes are at particular risk, but those traveling by any mode in rural areas face increased risk of traffic death compared to their urban counterparts: while only 19% of the US population lives in rural areas, they account for 49% of all traffic deaths. About 75% of all roads in the United States (around 3 million miles) are in rural areas and are vital for transporting goods and connecting communities, and small-town main streets are also often state highways that carry significant regional and truck traffic. According to a study published by the Governors Highway Safety Association, the risk of dying in a car crash, whether inside or outside a vehicle, was 62% higher on a rural road compared to an urban road for trips of the same length.

Nationally, pedestrian and bicycle fatalities have been increasing in recent years. In 2020, 67% of pedestrians killed by vehicles occurred along roadways without sidewalks. People of color, particularly Native and Black Americans, are more likely to die while walking than any other race or ethnic group. Studies have shown that even having wide shoulders along roads can reduce pedestrian crashes by up to 70% with sidewalks providing up to an 88% reduction.

The Federal Highways Association (FHWA) released the Small Town and Rural Multimodal Networks Guide in 2016 which covers rural active transportation issues in greater detail and provides model facility types that fit rural and small-town contexts.

As an additional focus area for active transportation, safe routes to schools are an important component of any thriving community. As noted, the obesity rate for rural children is a growing concern in the US. Many rural communities have constructed new schools on the periphery of a community where it is unsafe to walk or bicycle. Keeping centralized schools that are close to neighborhoods or school sites that have good connectivity by active transportation makes it safer and more appealing for students living nearby to walk, bike, or roll to school.

The National Center for Safe Routes to School supports communities that want to encourage active transportation to reduce child obesity, decrease traffic congestion near schools, and increase community connectedness. As of 2011, 41% of Safe Routes to School grants went to small towns and rural areas.

More than one million households in predominantly rural counties do not have access to a vehicle. As stated previously, the latest American Community Survey (ACS) data indicated that in 164 rural US counties, at least 10% of households don’t have access to a car. Rural communities can benefit from accessible transit service that connects people to the greater region. Transit is essential for many rural residents, such as families without access to a vehicle, and older residents who are no longer able to drive to reach health care, groceries, and other crucial services. Rail service through Amtrak or regional services may also provide economic and transportation benefits to some communities that have access to it, as in the case of Sacco and Brunswick, Maine. The preservation of these services should be a priority. Unfortunately, around 30% of rural areas have no access to any type of transit service at all. Other strategies for improving transit service in rural areas include exploring on-demand bus service options (see the example from Chillicothe, OH) and establishing community partnerships to make fixed-route bus service affordable for residents (see Paris, TX).