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Rural Health Information Hub

What is Rural?

Rural is an inexact term that can mean different things to different people, organizations, and governments. Trying to define “rural” is a challenging task in a nation with diverse geography and changing demographics. However, a precise definition of rural is important to those interested in rural issues. Federal and state policymakers, funders, service providers, and researchers need a clearly stated definition that is current in its interpretation.

Numerous federal and state-level definitions of rural have been created over the years for various programs and regulatory needs. However, there are three federal government agencies whose definitions of what is rural are in widest use:

  • The U.S. Census Bureau
  • The Office of Management and Budget (OMB)
  • The Economic Research Service of the U.S. Department of Agriculture (USDA-ERS)

While some definitions of rural are very broad, or merely what is left over after urban is defined, several government agencies have created detailed and nuanced definitions of rural to inform rural-specific research, policies, and programs. These definitions also permit some flexibility, such as allowing users to select from varying degrees of rurality. Agencies involved with rural health services will continue to adapt their definitions, striving to better serve the needs of the rural population. This guide focuses on identifying and describing the various federal definitions and classification schemes for rural in current use, and helping users find the appropriate rural definition for program planning, policymaking, and research.

Frequently Asked Questions

Why do we need rural definitions and how are they used?

Rural definitions are very important for government functions related to rural policymaking, regulation, and program administration. In addition, many non-governmental organizations need to use rural definitions in their programming, research, and communications efforts. Generally, there is not one definition that fits all needs or programs. Each organization or government agency selects the best definition that facilitates the purpose of their work or programs.

Examples of how rural definitions are used include:

  • Determining eligibility for rural grant programs. Funding agencies and organizations have to draw a line somewhere, and communities on one side of that line are eligible while those on the other side are not.
  • Implementation of programs and laws that concern rural areas requires that policymakers, regulators, and administering agencies stipulate how rural will be defined.
  • Research and data collection requires statistical consistency and accuracy, as well as validation, by researchers and government agencies. Researchers must choose and consistently use a precise definition of rural.

For additional information, see Considerations for Defining Rural Places in Health Policies and Programs.

Who created the major definitions of rural and what are the principal differences between these definitions?

There are three government agencies whose definitions of rural are widely used: the U.S. Census Bureau, the Office of Management and Budget, and the Economic Research Service of the U.S. Department of Agriculture.

U.S. Census Bureau

Initially defines specific urban entities. Areas that are not defined as urban are considered rural.

  • In March 2022, the U.S. Census Bureau published updated criteria informing how it will define urban areas based on the results of the 2020 Decennial Census. For the 2020 Census, an urban area must meet minimum housing unit density and/or population density requirements. An initial urban area core must have 425 housing units per square mile. An urban area must have at least 2,000 housing units or a population of at least 5,000. In addition, the Census Bureau no longer distinguishes between an urbanized area and an urban cluster.
  • The Census Bureau's classification of “rural” consists of all territory, population, and housing units located outside urban areas. The Bureau's definition is the only federal definition that applies the term “rural” in an official, statistical capacity, allowing it to be viewed as the official or default definition of rural.

Since these definitions are based on the decennial census, areas identified as rural may change each decade following the results of the census. For example, prior to the 2020 Census, the U.S. Census Bureau also defined Urban Areas and Urban Clusters. An Urbanized Area (UA) had an urban nucleus of 50,000 or more people. Individual cities with a population of 50,000 may or may not have been contained in these UAs. Urbanized Areas had a core (one or more contiguous census block groups or BGs) with a total land area less than two square miles and a population density of 1,000 people per square mile. They could contain adjoining territory with, at minimum, 500 people per square mile and encompass a population of at least 50,000 people.

An Urban Cluster (UC) also had a core as identified above with a total land area of less than two square miles and a population density of 1,000 people per square mile. They may have contained adjoining territory with, at minimum, 500 people per square mile. Urban Clusters encompass a population of at least 2,500 but less than 50,000 persons.

For additional information about U.S. Census Bureau definitions and classifications for rural, see the Census Bureau's Urban and Rural page.

Office of Management and Budget (OMB)

Defines metropolitan statistical areas, or metro areas, as central or core counties with one or more urbanized areas as defined by the Census Bureau, and outlying counties that are economically tied to the core counties as measured by work commuting. Outlying counties are included in a metropolitan statistical area if 25 percent of workers living in the county commute to the central counties, or if 25 percent of the employment in the county consists of workers coming out from the central counties — the so-called “reverse” commuting pattern.

Nonmetropolitan (nonmetro) counties are outside the boundaries of metro areas and are further subdivided into two types:

  • Micropolitan statistical areas, or micro areas, are any nonmetro counties with an urban cluster of at least 10,000 persons. It is further defined as the central county of a micro area and adjacent outlying counties. As with metro areas, outlying counties are included if commuting to the central county is 25 percent or higher, or if 25 percent of the employment in the outlying county is made up of commuters from the central county.
  • Noncore counties are nonmetro counties that do not meet the requirements to be a micropolitan statistical area.

Another classification strategy for rural based on the OMB's method of identifying metropolitan and nonmetropolitan counties is the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties. This classification scheme includes the two types of nonmetropolitan counties (micropolitan statistical areas and noncore counties). However, it further divides metropolitan statistical areas into 4 levels: large central metro, large fringe metro, medium metro, and small metro. This scheme is used by NCHS to investigate the relationship between health and degree of urbanization, and to compare health characteristics in rural and urban counties.

See the U.S. Census Bureau's Metropolitan and Micropolitan page for more information about OMB definitions of rural.

Researchers and others who discuss conditions in rural America often refer to nonmetropolitan areas that include both micropolitan and noncore counties collectively as rural areas.

Economic Research Service, U.S. Department of Agriculture (USDA-ERS)

USDA-ERS and the Federal Office of Rural Health Policy collaborated to develop the Rural-Urban Commuting Area (RUCA) system. This method is gaining in popularity at several government agencies, particularly for use in identifying rural areas within metro counties. The Federal Office of Rural Health Policy uses the RUCA methodology in determining rural eligibility for their programs. For more about RUCAs, see the FAQ What are RUCA codes? and Rural-Urban Commuting Area Codes (RUCAs).

Another classification method created and used by USDA-ERS is Rural-Urban Continuum Codes, which distinguish metropolitan counties by size and nonmetropolitan counties by their degree of urbanization and proximity to metropolitan areas.

USDA-ERS provides information about several other Rural Classifications including the Frontier and Remote Area (FAR) Codes, which describe areas using a combination of population density, the distance to Urbanized Areas, and the Urban-Influence Codes (UICs), which describe nonmetropolitan counties by size of the largest city or town and proximity to metro and micropolitan areas.

Table 1. Comparison of Rural Definitions
Definition & Agency Geographic Unit Used What is Included in “Rural” U.S. Rural Population*
Urban and Rural Areas
U.S. Census Bureau
Census Blocks and Block Groups Rural areas encompass all population, housing, and territory not included within an urban area. 66,610,922

Percent of Total Population:
Core Based Statistical Areas (Metropolitan, Micropolitan, Noncore)
U.S. Office of Management & Budget

Metropolitan areas contain a core urban area population of 50,000 or more. Nonmetropolitan areas contain a population of less than 50,000. This includes both micropolitan areas, with urban cluster populations of 10,000 to 50,000, and all counties that lack an urban core, which are referred to as noncore counties.
County All nonmetropolitan areas (counties) including micropolitan and noncore counties 46,293,406

Percent of Total Population:
Rural-Urban Commuting Areas (RUCAs)
Economic Research Service

Utilizes the U.S. Census Bureau’s UAs and UCs definitions with information on work commuting. Classification delineates metropolitan, micropolitan, small town, and rural commuting areas with whole numbers 1-10 and further subdivides into 21 secondary codes based on commuting flows — local or to another census tract.
Census Tract, ZIP Code approximation Primary RUCA codes 4 and above (Micropolitan Area Core, population up to 49,999) 51,112,552

Percent of Total Population:
Sources: 2020 Census Urban Areas Facts, U.S. Census Bureau; 2010 Rural Urban Commuting Area Codes, USDA-ERS; Urban Influence Codes, Documentation, 2013, USDA-ERS

*Note: U.S. Census Bureau uses 2020 Census data. OMB and USDA-ERS population figures are based on 2010 Census data. OMB and USDA-ERS will release updated population figures using 2020 U.S. Census data in 2023/2024. All data includes the 50 states, District of Columbia, and Puerto Rico. For more information, see What changes to rural definitions are occurring following the 2020 Census?.

Why are there multiple government definitions for rural?

For many years, the federal government has been classifying areas and population for statistical purposes and to target programs and funds. Federal agencies create and use definitions to facilitate their own programs because no single definition clearly divides rural and urban entities. Thus, over time, many definitions have been developed by different agencies for various purposes using different classifications. All have strengths and weaknesses and are used by government agencies depending on which one best fits their programmatic goals.

For example, the Office of Management and Budget (OMB) created the designation of metropolitan and micropolitan areas to create consistency in data collection across federal statistical agencies. Though these definitions were not intended to be used for programmatic purposes, nonetheless they are.

For additional information on the different types of rural definitions used by the federal government, see Why Definitions Matter: Rural Definitions and State Poverty Rankings and ERS: Rural Classifications.

How do I know which definition I should use?

There are many different circumstances in which an appropriate rural definition must be selected and used. Selecting an appropriate definition may vary depending on your role:

Grant applicants
Applicants for funding opportunities should use the rural definition specified in the funding announcement. If one is not specified, potential applicants should contact the funder to identify which definition is acceptable for determining eligibility. Some programs do not require rural status but may be interested in it as one factor illustrating need. In that case, consider which definition best fits the population or service area the program would address.

Funders and program administrators
When establishing funding or other programs for rural areas, organizations must either define rural themselves or choose an existing definition of rural to determine eligibility. When choosing an existing definition, organizations may wish to consider the ease of determining rural status under each definition, the availability of data of interest to the target population, as well as which definition is the closest fit to the population the program is designed to serve. Some definitions rate rural status along a continuum, which gives programs flexibility to use a tighter or looser definition.

There are numerous considerations regarding defining rural in research studies. For more information, see How do you select an appropriate rural definition for a research study? on our Conducting Rural Health Research, Needs Assessments, and Program Evaluations topic guide.

How do differing definitions contribute to confusion about rural places and populations?

While rural definitions are designed to precisely define what is rural, the fact that there are many different definitions often creates confusion, particularly for people who are not aware of the various definitions of rural. They may hear different numbers for the same rural statistic and wonder which one is correct, not realizing that they are both correct, but based on different definitions. When using rural statistics, it is important to understand which definitions were used to ensure that comparisons are fair and appropriate.

Confusion can also occur for rural organizations when they qualify for one rural program but not another. Other times, organizations might know they fit within a federal rural definition and then are surprised to not qualify for a specific rural program that utilizes a different definition.

Examples of this type of confusion include:

  • A large county of several thousand square miles may have an urban center with a population greater than 50,000 within its boundary, which would classify it as a metropolitan county by the OMB definition. However, there may be many areas within this same “metropolitan” county that would be classified as rural by the Federal Office of Rural Health Policy (FORHP) definition that uses a more site-specific census tract population. While metropolitan counties may not be eligible for some programs designed for rural areas, rural areas within a metropolitan county may be eligible for other rural-focused programs using the FORHP definition. Large counties with great expanses of rural areas are frequently found in the Midwest and the Western portions of the United States.
  • The Centers for Medicare & Medicaid Services (CMS) uses a definition of rural based on Urbanized Areas (UAs) and Urbanized Clusters (UCs) classifications for Rural Health Clinic determinations. However, FORHP uses the RUCA method to determine rural areas of census tracts within counties. As a result, Rural Health Clinics could be located in an area identified as rural by CMS but as non-rural by FORHP.
  • The USDA-Rural Development (USDA-RD) bases eligibility for its programs on the total population of a city, town, or unincorporated area. Several programs have an eligibility limit of 50,000 people; however, there may be an additional restriction regarding proximity to a municipality greater than 50,000. Many of these programs are used for business development. For example, the USDA-RD Community Facilities Loan and Grant Program, which supports rural healthcare projects, uses a more restrictive definition of rural. The eligibility limit is a city, town, or an unincorporated area with a population that is 20,000 people or fewer. Other USDA-RD programs have an even more restrictive definition that confines eligibility to those municipalities of 10,000 or fewer. See the USDA-RD's Report on the Definition of “Rural” for additional information.

How can I verify that my geographic area status is rural?

RHIhub's Am I Rural? tool can be used to help determine whether a specific location is considered rural based on various definitions of rural, including those used as eligibility criteria for federal programs, such as those administered by the Centers for Medicare & Medicaid Services and the Federal Office of Rural Health Policy. HRSA's Rural Health Grants Eligibility Analyzer determines official geographic eligibility for rural health grants. HRSA also offers a Medicare Telehealth Payment Eligibility Analyzer and a Medicare Physician Bonus Payment Eligibility Analyzer. The information provided by these tools addresses only the rural aspect of a program's requirements.

For additional information about accessing statistics and data regarding rurality and rural health, see RHIhub’s Finding Statistics and Data Related to Rural Health topic guide.

What is the Goldsmith Modification?

In 1992, the Goldsmith Modification was created to recognize small towns and rural areas found in large metropolitan counties. Some of these communities had greater distances or physical features limiting access to health services. This variation expanded the eligibility for rural health grant programs to assist isolated rural populations in large metropolitan counties. The Goldsmith Modification preceded the RUCA methodology (see What are RUCA codes?) and is referenced in many publications on rural definitions. For additional information about the Goldsmith Modification, see Improving the Operational Definition of “Rural Areas” for Federal Programs.

What are RUCA codes?

Rural-Urban Commuting Area codes, or RUCAs, are a Census tract-based classification scheme that use Census Bureau Urbanized Areas and Urban Clusters in combination with commuting information to characterize the rural and urban status of every census tract nationwide and their relationships. In 1998, the Health Resources and Services Administration's Federal Office of Rural Health Policy, the WWAMI Rural Research Center at the University of Washington, and the USDA's Economic Research Service collaborated to create the initial version of the RUCA system that classifies sub-county areas on a scale from 1 to 10 representing urbanization, population density, and daily commuting patterns. RUCA codes represent the current version of the Goldsmith Modification.

Since their creation, the RUCA codes have been updated several times with new Census data. The most recent version of the codes was created by a collaboration between the USDA-ERS, FORHP, and the University of North Dakota Center for Rural Health. RUCA codes (2010) by state census tracts and a ZIP code approximation of RUCAs can be downloaded from the USDA-ERS website. Some federal programs have identified areas with a RUCA code of 4 through 10 as rural. The Federal Office of Rural Health Policy uses the RUCA methodology in determining rural eligibility for their programs.

What is meant by frontier?

Frontier areas are the most rural areas of the nation, which are sparsely populated and are isolated from population centers and services by distance or physical barriers. To learn about frontier definitions, including the Frontier and Remote (FAR) Codes, see the Health and Healthcare in Frontier Areas Topic Guide.

Where can I find a list of rural designated areas by census tracts, county, and/or zip code?

The Federal Office of Rural Health Policy (FORHP) maintains a List of Rural Counties and Designated Eligible Census Tracts in Metropolitan Counties using the RUCA methodology to determine rural designations for their programs. See the FAQ What are RUCA codes? for additional information.

Also, the Federal Office of Rural Health Policy Data Files include a set of 3 Excel files identifying rural areas as:

What changes to rural definitions are occurring following the 2020 Census?

In March 2022, the Census Bureau announced changes to how it defines urban areas based on the results of the 2020 Decennial Census. Urban areas are now defined by housing unit density rather than population density. The previous designations of urbanized areas and urban clusters are no longer used. The Census Bureau released updated lists and maps of urban areas using 2020 Census data. The Census Bureau also provides a table comparing the Urban Area criteria used following the 2010 Census and 2020 Census.

In July 2021, the Office of Management and Budget (OMB) announced its 2020 Standards for Delineating Core Based Statistical Areas, which will guide the classification of metropolitan and micropolitan statistical areas based on the 2020 Census. OMB plans to publish these new delineations in 2023. Similarly, USDA-ERS plans to release updated Rural-Urban Continuum Codes in 2023 and updated Rural-Urban Commuting Area codes no earlier than Fall 2024.

Why is my location not considered rural?

Your location may not be considered rural due to the definition of rural used by a particular program's requirements. Since different definitions of rural are used for different programs, your location may also be considered rural for the purposes of one program, but not for another program.

Even within the same definition, rural areas defined using census information may change following the release of new decennial census data. Thus, a location previously considered rural may no longer be classified as rural following updates using 2020 Census data, or vice versa.

Some programs provide a legacy clause; for example, Rural Health Clinics may initially be established in a rural area that is later reclassified as non-rural by the Centers for Medicare & Medicaid Services. However, as long as they stay in the same location, their clinic still qualifies for the Rural Health Clinic designation.

Who can I contact regarding geographic eligibility for various federal programs?

For Geographic Eligibility for Rural Health Grant Programs
Federal Office of Rural Health Policy
Telephone: 301.443.0835

For Geographic Eligibility for USDA - Rural Development Programs
Rural Development State Offices

For Geographic Eligibility for Medicare Programs
Contact your CMS Regional Office Rural Health Coordinator

Last Updated: 6/18/2024
Last Reviewed: 1/27/2022