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Rural Health Information Hub

Populations that Receive or Could Benefit From Increased Access to Transportation

Many transportation systems in rural areas are specifically designed to serve special populations, including children, older adults, veterans, tribal populations, and populations with disabilities or low income, among others. For an overview of considerations for implementing transportation programs for these populations, see Module 4 Implementation Considerations.


Transportation provides children living in rural areas with access to a range of essential activities, including school, day care, and medical appointments. Children who live in rural communities use transportation services to benefit from enriching community resources like libraries, afterschool care, sports, and entertainment activities. However, rural schools may struggle to meet the transportation needs of students due to long distances between schools and homes and the additional cost involved.

Older Adults

Rural communities have a higher percentage of adults over the age of 65 compared to other parts of the country. Older adults in rural areas primarily use personal automobiles for transportation. This puts them at risk of social isolation if they become unable to drive and cannot access other transportation options. A national study found that rural older adults scored lower in social functioning measures than urban adults, and would therefore be prone to social isolation. The authors suggested that rural older adults may benefit from increased social programming and community participation, which may require access to transportation. While older rural adults may qualify for medical transport through Medicare, options for non-essential transportation are more limited. Volunteer driver programs such as ITNCountry can also increase access to transportation for older adults.


Approximately one quarter (4.7 million) of American veterans live in rural areas. Geographic distance to Veterans Health Administration facilities prevents many rural veterans from accessing healthcare and human services. The U.S. Department of Veterans Affairs (VA) offers the Veterans Transportation Program (VTP) to help veterans travel to VA facilities. The VTP includes the Highly Rural Transportation Grants, which provide additional funds for transportation services in sparsely-populated counties. The VA developed a video that describes the issues that distance poses for veterans and how the VTP can increase access to medical care.

Tribal Populations

Tribal transportation refers to transportation on Indian Reservation Roads (IRR) which are roads that connect to tribal reservations and lands, as well as Alaska native villages. Despite their importance to quality of life and access to care, employment, and education, IRRs are underdeveloped when compared to other public road networks in the nation. Over half of the roads in the tribal transportation system are composed of “unimproved earth and gravel,” and approximately one quarter of bridges in the system are structurally deficient. These road conditions pose safety concerns for tribal populations and limit opportunities for economic expansion.

Funding for transportation in tribal areas may also require complex planning and coordination processes. Tribal transportation planning involves close collaboration between sovereign tribal governments and national agencies, like the U.S. Department of Transportation's Federal Highway Administration and the U.S. Department of the Interior's Bureau of Indian Affairs.

People with Disabilities

The Americans with Disabilities Act (ADA) seeks to ensure that all people with disabilities have access to safe, accessible transportation services. An estimated 15.3% of rural residents have a disability. Rural populations with disabilities often face additional barriers to accessing transportation than those without disabilities. For example, some disabilities can prevent individuals from driving a personal automobile or accessing fixed-route transport systems if vehicles are not adapted to meet accessibility needs. Transportation barriers can prevent rural populations with disabilities from receiving necessary health and human services and participating fully in society.

People with Low Incomes

Lack of transportation can prevent rural populations with low incomes from accessing employment opportunities and programs designed to alleviate poverty. Access to public transportation can be especially important for low-income families because it may reduce transportation-related expenses for the household. In 2014, families with lower incomes spent approximately 16% of their income on transportation-related expenditures, a significant increase from 9% in 2010. Households in the middle and upper income brackets spent a proportionately lower percentage of their income (11%) on transportation costs. Additionally, expenditures on both motor oil and gasoline doubled from 1996 to 2014.

Resources to Learn More

Child Care for Welfare Participants in Rural Areas
This Rural Welfare Issue Brief discusses transportation issues as they relate to populations with low incomes accessing child care.
Author(s): Colker, L.J. & Dewees, S.
Organization(s): Macro International Inc.
Date: 11/2000

National Tribal Transportation Conference
This website posts agendas and presentations from past and current National Tribal Transportation Conferences.
Organization(s): Western Tribal Technical Assistance Program Center, National Indian Justice Center

The Stranded Poor: Recognizing the Importance of Public Transportation for Low-Income Households
This issue brief discusses transportation access issues among low-income individuals and families, including employment, child care, school, healthcare, and elderly rural residents.
Author(s): Criden, M.
Organization(s): National Association for State Community Services Programs
Date: 2008

Tribal Transportation Best Practices Guidebook
This resource presents case studies of tribal transportation systems that have been successfully created and implemented in a variety of settings. It also describes some of the best practices used by those programs and identifies ways these practices can be integrated into other systems. Finally, it contains a list of references and checklists that can be used by groups interested in building or enhancing existing tribal transit systems.
Author(s): Southern, V.J.
Organization(s): Federal Highway Administration Office of Planning
Date: 12/2009