In rural communities, healthcare and the overall vitality of the community are intrinsically linked. A robust
community supports and sustains quality health and social services for its residents by attracting and retaining
well-trained and committed healthcare professionals. Communities with strong economies may be more likely to
financially support their healthcare system through philanthropic giving and by investing in infrastructure that
can be leveraged by the healthcare system. In return, a high-quality healthcare system can support economic and
community development initiatives. Together, strong rural economies and rural healthcare systems can address the
five domains of the Social
Determinants of Health: economic stability, education, health and healthcare access, the built
environment, and social cohesion.
This topic guide focuses on how community and economic development can complement health services in rural
areas, how rural communities can identify and build on their unique assets, and how collaboration between
various sectors can address challenges, including issues related to population health and public health.
Frequently Asked Questions
Community resilience is the capacity to prepare for, endure, and adapt to or recover from a natural disaster or
unexpected economic change based on a community's unique population needs, assets, location, and economic
Resilience and Vulnerability in the Rural West, a 2015 working paper from the University of Arizona
Department of Agricultural and Resource Economics, presents a system for assessing economic resilience and
vulnerability in rural counties by assessing variables including distance from metropolitan areas, percent of
public lands in rural counties, education, health, and economic diversity. These areas affect the resilience of
communities. In particular, the study found that access to healthcare is a significant factor for rural
resilience, as is environmental quality.
The 2018 research report Exploring
Strategies to Improve Health and Equity in Rural Communities from the NORC Walsh Center for Rural Health
Analysis notes that relationships between individuals and institutions across economic and service sectors
contribute to rural community resilience. These relationships can strengthen communities that face challenges
related to community well-being, access to services, and economic development. Community-driven partnerships
also impact the health status of rural communities, as they contribute to improvements in physical
infrastructure such as drinking water and wastewater facilities and investments in public parks. They also
generate support for local healthcare facilities.
As the NORC Walsh Center report notes, a number of studies, articles, and mainstream depictions of rural America
focus on problems, needs, or deficiency in resources, talent, industry, and health. While these are significant
issues that affect resilience and deserve attention, solely concentrating on problems and needs creates a
narrative that does not inspire growth. According to the authors of the report, “While it is important to
acknowledge and address these inequities and their root causes, it is essential to understand and leverage the
strengths and assets of rural places that serve as protective factors and could fundamentally improve health and
equity.” The report emphasizes that the strong relationships that shape rural communities are among their
most valuable assets, also noting that many rural areas possess significant natural, cultural, and historical
assets that can contribute to economic partnerships and resilience.
For an example of a region-specific overview of rural economic resilience, see the Appalachian Regional
Commission's 2019 report Strengthening
Economic Resilience in Appalachia, which includes a series of best practices for rural community
development and case studies.
What is asset-mapping and how does it contribute to rural community vitality?
Taking stock of a rural community's assets, including the skills and talents of its existing individuals,
businesses, organizations, and institutions, is an important part of assessing community needs and potential for
economic development. Asset mapping emphasizes the positive (what a community has to offer) over the negative
(what a community is deficient in) to focus the community on its strengths. Mapping the Assets
of Your Community: A Key Component for Building Local Capacity, a publication of the Southern Rural
Development Center, outlines the differences of needs-based and asset-based frameworks when approaching
community development. The author notes that conversations on “needs” often focus on deficiencies
lead to fragmented responses by community members or institutions who seem responsible for the issue.
Conversely, building on “assets” leads to collective efforts, shared talents, and community
empowerment. The report explains,
“Asset mapping begins with the philosophy that all local residents, regardless of age, gender,
race, ethnic background, place of residence, or other characteristics, can play an effective role in addressing
important local matters. Local people and organizations are encouraged to explore how problems might be
interrelated, and to respond to these issues in a coordinated, collaborative fashion.”
In rural communities, building on current assets is essential to economic development. Community assets that
contribute to vitality in different ways include:
Associations, such as business organizations, educational groups, neighborhood watches, and community-based
Individuals, whose skills, knowledge, experiences, educational backgrounds, and unique perspectives
contribute to holistic and equitable planning
Institutions, including public, private, and nonprofit agencies such as schools, libraries, religious
institutions, and healthcare facilities
Physical spaces, such as public recreation areas, parks, playgrounds, and gardens
Local economic institutions, including businesses, banks, credit unions, local foundations, and local
chambers of commerce
The Collaborative for Neighborhood Transformation's toolkit What
is Asset Based Community Development (ABCD) highlights the distinct strengths and limitations of
associations and institutions. Associations are governed by and serve citizens and are driven by the capacity of
their members, while institutions are governed by an organized or hierarchical structure, are driven by need for
service, and benefit clients or consumers.
According to the toolkit, communities should build social capital,
defined as networks of community members that increase participation in community and economic activity. Social
capital moves communities beyond service-client relationships, expanding relationships between institutions and
associations to empower citizens to pool their talents and skills.
Initiatives that aim to improve rural community-based health can also benefit from asset mapping. For example,
the Seneca Towns Engaging People for Solutions (STEPS) program seeks
to improve social, educational, physical, and economic health in the rural Finger Lakes communities of New York,
as discussed in the RHIhub Social
Determinants of Health in Rural Communities toolkit. The SDOH toolkit and the RHIhub Rural Community
Health toolkits further explore asset-based
community development and asset identification
For more on the benefits of asset-based strategies, see Asset-Based
Economic Development and Building Sustainable Rural Communities, a series of briefing papers from the
International City/County Management Association (ICMA) Center for Sustainable Communities. The brief discusses
asset-based economic development as a ground-up approach to growing rural and local economies based on existing
industries, emerging industries, and local talent. An additional resource for rural communities in Western
states is the Area Sector Analysis Process (ASAP), a program
developed by the Western Rural Development Center at Utah State University. ASAP works with rural communities to
identify goals, priorities, industry needs, and opportunities for economic development.
How do healthcare services, facilities, and providers contribute to the economic vitality of rural
Providing quality healthcare in a rural community goes beyond immediate healthcare services; it also has a
positive impact on the economic health of a community. Rural healthcare systems are often one of the largest
employers in their community, as noted in this 2017 publication from the
American Hospital Association. They offer some of the best paying jobs available in rural areas, bringing
professionals in to live and invest in the community. This perspective
piece from the National Rural Health Association outlines the impacts of rural hospitals on economic
activity and growth.
According to the American Medical Association's Physicians
Boost the Economy, a physician in a community translates into real revenue and real jobs. A 2018
report, The National
Economic Impact of Physicians, offers state-level data on the economic impact of patient care physicians,
although it does not represent rural economic impact specifically. A 2016
report from the National Center for Rural Health Works (NCRHW) estimates that a rural primary care
physician can generate more than $1.4 million in wages, salaries, and benefits and 26.3 jobs in a local
community with a hospital.
Some specific examples of how local healthcare services can impact the economy include:
A 2017 USDA study found that
inpatient healthcare facilities were responsible for 1.25 million jobs, or 8.5% of wage and salary
employment in rural communities at their peak in 2011.
As detailed in a 2014
presentation, the Rural Wisconsin Health Cooperative (RWHC) found that when a local hospital offers
a key service such as a dialysis facility, people stay in the community for care instead of traveling to
urban centers and investing there. Moreover, rural health insurance premiums and taxes only come back to the
community and create jobs if there are local healthcare providers offering services in the community.
According to a 2016
assessment from the NCRHW, for every job in a Critical Access Hospital, another 0.34 jobs are
created in other local businesses and industries. A Critical Access Hospital generates an average of $1.8
million in taxable retail sales in the rural community.
Why should local healthcare leadership be involved in community and economic development efforts and what role
can they play?
Healthcare is big business and, together with social services and education, is one of the top 3 employers in
rural communities according to the U.S. Census Bureau article Beyond the
Farm: Rural Industry Workers in America. Because the healthcare sector is a major economic contributor
and a sought-out amenity for businesses and individuals looking to move into a community, the input of
healthcare leadership is important to local development efforts.
Rural healthcare leaders can play a role in community and economic development efforts through involvement in
local organizations, schools, chambers of commerce, philanthropy, and events. Partnerships between healthcare
leaders and other institutions and individuals in rural communities are essential to fostering economic
development. According to a 2021 case study from the American Hospital Association, The
Hospital as a Convener in Rural Communities, rural facilities can play a key role in bringing together
stakeholders in education, behavioral health, housing, food, transportation, and government. In 2016, the
National Alliance of Community Economic Development Associations held the Community Development and the Social Determinants of Health
Symposium, offering links to presentation slides and recommended readings on community development to
support health and wellness.
Healthcare leaders' participation in activities such as county/regional boards and leadership institutes can
promote local healthcare awareness among current and developing leaders. By conducting an economic impact
analysis, they can inform other community leaders and the community at large about the jobs and dollars brought
into the community through healthcare services.
How can the availability of healthcare services be leveraged in economic and community development
Healthcare services are important to community and economic development not only in terms of the employment and
labor income generated in the local economy, but also to attract and retain business and industry. As remote
work and web-based employment become more popular and necessary during public health emergencies like the
COVID-19 pandemic, access to healthcare is an important consideration for workers to continue to live in or
relocate to rural areas.
Retirees are more likely to move to or stay in rural communities with quality healthcare facilities, and data
have demonstrated that retirees can substantially impact the local economy. For example, the 2018 report Evaluating Retiree-Based
Economic Development in Georgia: Golden Rules shows that bringing retirees into a community grows and
diversifies the local economy, with 55 jobs generated for every 100 new retirees in rural Georgia.
Healthcare leadership should be involved in community and economic development to assure that the healthcare
services needed for attracting and retaining businesses, industries, and retirees are provided locally. Rural
hospitals can also play a role in the community by working with high schools and community colleges to develop
the emerging workforce.
How can communities illustrate the importance of healthcare to our local economy?
An economic impact study of healthcare in a rural community will illustrate the importance of healthcare to the
local economy. With an economic impact study, healthcare and community leaders can demonstrate, with local data,
the significance of the healthcare system to the community. This can help community members fully understand the
importance of the entire health sector, any component of the health sector, or a specific health
An economic impact study can engage the community to be involved in local healthcare issues. Outcomes of a
community economic impact study may include engaging the community to:
Assist in finding solutions to healthcare challenges
Participate in a community health needs assessment process
Increase local support and utilization of a particular health service or all health services
Increase access to local healthcare services through the expansion of their rural healthcare system and the
development of new healthcare programs
Gain local support for a capital improvement campaign to construct new facilities, expand current
facilities, or purchase new equipment to provide the latest medical technology
Assist in obtaining capital funding from investment and banking institutions
Consider healthcare as an economic development tool to encourage new business and industry, and to attract
retirees to the community
Ensure the ongoing existence of local health services
Establish or increase community infrastructure, such as broadband
The USDA Economic Research Service's 2017 report Employment Spillover Effects of Rural
Inpatient Healthcare Facilities estimates a lower inpatient healthcare facility employment multiplier
for micropolitan counties at 1.24 jobs per healthcare job, further estimating .89 jobs for rural noncore
counties. The authors note that this difference is expected, as micropolitan areas are more economically
integrated with goods and services contained within the same county, compared to more rural areas.
A 2019 report on hospital community benefits
prepared for the American Hospital Association found that tax-exempt hospitals provide an estimated $95 billion
in community benefit nationwide, a value 11 times that of the tax revenue forgone by granting non-profit
hospitals tax-exempt status. On the other hand, hospital closures can negatively impact community economic
health. According to a 2006 study, rural
hospital closures reduce per-capita income by $703 and increase unemployment rates by 1.6%.
The Center for Economic Analysis of Rural Health offers mapping tools
and resources that support efforts to make rural healthcare more sustainable and that communicate the importance
of health systems to rural communities. Their Healthcare
Industry Characteristics map, for example, provides county-level data on healthcare employment, job
postings, and wages that can be useful for comparisons in an economic impact study.
Where can our rural community find the resources to determine the economic impact of our healthcare sector or a
component of the healthcare sector?
If local leaders or healthcare organizations need assistance to measure the economic impact of a health sector
component, the first contact should be with their State
Office of Rural Health. In many states, the State Office of Rural Health, the state Cooperative
Extension service, state Area Health Education Centers (AHECs), or the state hospital association have trained
staff available to conduct health economic impact studies at no or nominal cost. Partnerships established with
these state-based organizations can serve as a resource for conducting a local healthcare economic impact study.
For distinct health-related projects, such as those funded by grants, RHIhub's Economic
Impact Analysis Tool shows how a project's spending on staff, supplies, equipment, and other expenses
benefits the community. Originally developed by the Lewin Group for the Federal Office of Rural Health Policy's
community-based grantees, this tool uses formulas to estimate the economic impact of grant program investments;
however, it can also be applicable to other non-grant funded projects. The calculations help rural program
grantees and other rural programs demonstrate the economic impact of their program's spending and provide tools
for those organizations to advocate for resources that contribute to program sustainability and improved
healthcare for rural populations.
Where can our community find training on economic impact and other tools to enhance our local healthcare
services and ultimately enhance our local community?
The Center for Rural Affairs provides comprehensive rural community
development services and focuses on policies that support rural community development, resource stewardship, and
small farms and businesses. The organization offers trainings on rural topics and produces publications on rural
issues. The Heartland Center for Leadership Development provides
training and services in leadership, community development, strategic planning, evaluation, and
entrepreneurship. The Center for Economic Analysis of Rural Health also
Wisconsin Health Cooperative's Community Economic Development Program offers quarterly trainings on
economic development issues for healthcare leaders and economic development professionals interested in
collaborating with healthcare institutions. Additionally, RWHC provides local technical assistance and data
analysis to rural healthcare institutions looking to engage in community economic development in their
USDA Rural Development administers several Programs &
Services for Communities & Nonprofits throughout rural America. Contact your state or local Rural Development office or your
local USDA Service Center for
additional information regarding technical assistance and funding to support self-sustaining, long-term rural
How does the vitality of a rural community affect health workforce recruitment and retention?
Every community has assets and challenges that impact efforts to recruit and retain medical staff. Recruitment
and retention efforts must also take into consideration location and the particular needs of the population and
patients that the healthcare organization serves.
Apgar Program, developed through a collaboration of Boise State University and the Family Medicine
Residency of Idaho, analyzed the relative importance of key factors for recruitment, along with the common
advantages and challenges that rural communities face in this process. The factors used by this program fall
into the categories of geographic, economic, scope of practice, medical support, and facility and community
support. Specific factors include schools, housing availability, climate, loan repayment, emergency care, mental
health, nursing workforce, specialty care, electronic medical records, and other elements which characterize the
community's capability to recruit and retain physicians.
Rural healthcare facilities and community leaders can collaborate to overcome challenges to recruiting and
retaining medical staff. They can analyze the community's advantages and challenges, leverage assets, and
address problem areas. An improved understanding of the factors that make a community unique can help leaders to
decide where to focus recruitment strategies and investments and how to structure the interview process and
retention plans. Place-based economic development, as described in this Urban Institute report,
focuses on developing vibrant communities to attract workforce talent rather than attracting business investment
RHIhub's topic guide Recruitment and Retention for
Rural Health Facilities provides information and resources regarding strategies and incentives to help
rural communities attract and retain healthcare providers.
What opportunities are available for rural communities to invest in their infrastructure to support their
Several federal agencies sponsor programs to strengthen the infrastructure in rural communities. Projects funded
by these agencies may strengthen and support local healthcare, such as road improvements and broadband
capabilities to facilitate access to healthcare.
USDA Rural Development offers grants, grant/loan combinations, and loans
public bodies, private non-profit corporations, and tribal governments to finance or assist in community
development. For the best program that would fit your community needs, contact your local USDA-RD Service Center.
Investment in broadband internet infrastructure is a critical issue in rural areas. The COVID-19 pandemic has
made it clear that broadband availability is a necessity for rural community vitality, as broadband is necessary
to access telehealth services, which providers are increasingly seeking to extend to rural populations.
Broadband is also a factor in a community's ability to attract employers in the tech industry, to support
education, and to provide the infrastructure needed for rural residents to work remotely. The Rural
Monitor article Broadband in Rural
America: Faster Speeds for Home and Healthcare explores the importance of broadband to accessing
telehealth services and supporting remote work capacity in rural areas. For information about broadband coverage
in your area, see the Federal Communications Commission (FCC)
Broadband Map. The map may not always be precise, however, as it provides information on broad coverage
The Center on Rural Innovation, an organization that partners with rural communities to explore options for
investing in internet infrastructure, offers a rural
opportunity map to help communities understand the economic dynamics in their area and a toolkit for
communities seeking to develop digital-based jobs. For more on the importance of broadband to rural healthcare
access, see our Health Information Technology topic
The Federal Office of Rural Health Policy offers telehealth
grant programs to expand telehealth technologies for healthcare delivery, information services, and
education. For more information on telehealth and telehealth-related funding opportunities, see RHIhub's Telehealth Use in Rural Healthcare topic guide.
Additional funding programs can be found in RHIhub's Funding & Opportunities section
where you can browse by topic and by state.
Why is it important to consider the capacity of the local healthcare system to anticipate economic growth?
When economic growth occurs, the capacity of the local healthcare system may need to increase to support
services for new families and businesses. This, in turn, would generate additional economic growth in the
healthcare sector. If the healthcare system is challenged to keep pace with the health needs of the growing
community, the lack of adequate capacity could affect access and quality for everyone, including both long-time
community members and new residents. Families and businesses may seek healthcare outside the local area or not
at all, decreasing the economic impact of these new businesses and families.
It is important that community-based economic development officials and businesses share information with their
local healthcare system about expected major economic growth. This will allow healthcare facilities to plan for
growth that may increase demand for services, as well as factors that may affect their expenses, such as
increased competition for workers. When healthcare facilities are not prepared for major economic growth in the
community, it places significant strains on facilities as they try to meet the changing needs of the
What is the role of philanthropy and nonprofit organizations in community development?
While there are many nonprofit organizations and philanthropic foundations that support the health and service
needs of specific populations or specific regions, rural America has historically received a far smaller share
of grant funds compared to metro-based organizations. A 2015 study from the USDA Economic
Research Service (ERS) found that rural organizations were awarded only 5.5% of U.S. foundation grants, on
average, from 2005-2010. This figure does not consider grants awarded to urban communities that benefit nearby
Challenges that impact rural organizations seeking grant funds include demonstrating impact in areas with lower
population and therefore fewer clients served, matching fund requirements, and limited resources or staff. For
more information on philanthropy in rural areas and strategies for building partnerships with foundations, see
the RHIhub Rural Philanthropy toolkit developed in
collaboration with the NORC Walsh Center for Rural Health Analysis.
Some organizations in rural communities have approached grant funding and grantmaking collectively,
to pursue innovative economic development strategies by building on natural, cultural, or other non-financial
assets. For example, Thrive
Regional Partnership brings together stakeholders from the tri-state Chattanooga region of southeast
Tennessee, northwest Georgia, and northeast Alabama, including 15 rural communities, to sustainably grow
industry and regional wealth.
Similar partnerships have brought together federal and philanthropic funds to improve healthcare access and
quality of care. In 2015, the Rural Health Aligned Funding Initiative
grew out of a partnership between philanthropies, federal agencies, and healthcare representatives, principally
funded by the Federal Office of Rural Health Policy and philanthropic resources. The project targets care
coordination to address health inequity in rural communities. The Rural Monitor article Rural Health
Philanthropy Partnerships: Leveraging Public-Private Funds to Improve Health describes the program and
two of its community partners, one in West Virginia and the other in eastern Washington.
To learn more about rural philanthropy, see our page on Rural Health Philanthropy.
For technical assistance and funding to support self-sustaining, long-term rural development, contact USDA Rural Development, your local USDA-RD Service Center or
your state USDA-RD office.
The Center for Economic Analysis of Rural Health also offers resources
and training opportunities for local leaders seeking to improve the sustainability of rural healthcare
Grantmakers in Health is a membership organization that works with
philanthropic organizations and health funders, providing technical assistance and collaborative support.
Wisconsin Health Cooperative's Community Economic Development Program offers educational and
networking opportunities for healthcare leaders interested in growing their involvement in and knowledge of
economic development as well as economic development practitioners interesting in collaborating with
healthcare institutions. The program also offers local technical assistance and data analysis services
tailored to the needs of individual healthcare organizations and their communities.