Rural vs Urban Healthcare
Key Differences and Challenges
Access to quality healthcare is essential for every community. But where someone lives influences their access to medical services, overall health outcomes, and the challenges they face. For healthcare professionals and practice administrators, understanding these differences between rural va urban healthcare is an important part of delivering effective care and implementing real solutions.
Rural vs Urban Definition
Before we get into the specific challenges, let’s clarify what rural and urban mean in the healthcare landscape.
Urban Definition
Urban areas refer to highly developed, densely populated areas, such as cities and large towns. Think New York City or Los Angeles, California. Urban areas are characterized by:
- Superior access to resources: Access to large hospitals, specialists, and advanced medical technologies.
- Higher population density: Greater demand for healthcare services due to a dense population.
- Infrastructure advantages: Access to reliable public transportation, better roads, and internet access, which makes access to services, information, and care easy.
The United States Census Bureau officially classifies an urban area as one with at least 2,000 housing units (homes or apartments) and a population of at least 5,000 people.
Rural Definition
The United States Census Bureau doesn’t have a specific definition for rural areas. It instead classifies any area that doesn;t fit the urban definition as rural. By default rural areas are then those with low population densities, limited development, and reduced access to services and characterized by:
- Lower access to healthcare with longer travel times: People often live far from hospitals or clinics. The average travel time to get high-risk surgical care in rural areas was 69 minutes in 20201
- Fewer providers: 29% fewer physicians per 100,000 people than in urban areas2
- Limited infrastructure: Reliable transportation and broadband access can be sparse or nonexistent.
At least 14% or one out of every seven people live in rural areas.3
The definition of rural varies by policy, research requirements, and agency standards. For example, the U.S. Census Bureau and the Office of Management and Budget (OMB) use different criteria when classifying areas as rural. If you’re curious whether your location fits, tools like the RHIhub’s “Am I Rural?” Tool make it easy to find out.
Rural vs Urban Healthcare
Urban Healthcare
Health issues in urban areas are often linked to the environment or lifestyle, such as pollution, infectious diseases, chronic conditions, such as diabetes, heart disease, stroke, or cancer, and injuries due to violence.
Rural Healthcare
Residents of rural areas tend to have more chronic health conditions and generally are less healthy. People in rural areas have higher rates of uninsurance and disability as well.
Urban vs Rural Healthcare at a Glance
| Urban | Rural | |
| Risk of dying from heart disease4 | Lower | Higher |
| Risk of dying from cancer4 | Lower | Higher |
| Risk of dying from accidental injury4 | Lower | Higher |
| Risk of dying from chronic lower respiratory disease4 | Lower | Higher |
| Risk of dying from stroke4 | Lower | Higher |
| Median age5 | 36 | 43 |
| Suicide rate5 | Lower | Higher |
| Average travel time to hospital6 | 17 minutes | 10.4 minutes |
Key Challenges in Rural Healthcare vs Urban Healthcare
Both rural and urban regions face unique healthcare barriers that affect access, affordability, and outcomes. But the challenges between the two differ.
Challenges Unique to Rural Healthcare
- Fewer providers: Rural residents are more likely to face healthcare provider shortages, including primary care physicians, nurse practitioners, dentists, and specialists. And many rural hospitals face financial challenges. Between 2017 and 2023 61 rural hospitals closed and only 11 opened.7
- Travel distances: Patients may need to drive long distances to receive care, which isn’t always feasible, especially for older adults or people without reliable transportation. Add to that that ambulatory care may have to travel to and from the patient’s residence, doubling travel time.
- Healthcare costs: Rural patients often face higher hospitalization and insurance premiums compared to urban residents.
- Lower health outcomes: The CDC reported that conditions like diabetes, coronary heart disease, and early deaths from preventable causes are more common in rural areas.
- Lack of health literacy: With fewer primary care providers and limited access to digital health resources, rural residents may be disconnected from essential health information.
Challenges Unique to Urban Healthcare
- Overcrowded facilities: Urban hospitals and clinics often deal with overwhelming patient volumes, leading to longer wait times and overworked staff.
- Pollution and housing: Urban residents face risks from poor air quality, limited greenspace, and substandard housing conditions — all of which can negatively impact health.
- Chronic illnesses and lifestyle concerns: Unhealthy diets, physical inactivity, and noncommunicable diseases, such as diabetes, cardiovascular issues, are more common in urban areas.
- Health inequality: Despite the availability of advanced healthcare services, socio-economic disparities often prevent marginalized communities within urban areas from receiving the care they need.
Why Location Matters
Healthcare access isn’t just about proximity to doctors and hospitals — it’s also about systemic challenges, policy definitions, and the infrastructure that supports care delivery. For example, an area previously classified as rural might lose that designation due to updated census data, which impacts eligibility for federal funding.
Healthcare professionals must be aware of how shifting geographic classifications — and their corresponding policies — can impact the communities they serve.
If you’re uncertain about your location’s classification or program eligibility, try using tools like the USDA Rural Health Guide to clarify definitions.
Moving Toward Solutions
Improving rural vs urban healthcare access requires tailored interventions. Here’s how healthcare providers and organizations can break down barriers to healthcare in rural areas and bridge the gap.
For Rural Areas
- Telehealth expansion: Use telehealth solutions to connect patients with providers, particularly for routine consultations and follow-ups.
- Mobile health units: Deploy mobile health clinics to bring care directly to underserved areas.
- Support healthcare providers: Offer incentives, such as student loan forgiveness and housing support, to encourage providers to work in rural clinics and hospitals.
- Use technology created specifically for rural hospitals and clinics, like the Azalea Health Hospital EHR or Ambulatory EHR
For Urban Areas
- Reduce facility overcrowding: Offer incentives, such as student loan forgiveness and flexible hours, to encourage more doctors and nurses to onboard and stay.
- Community health campaigns: Drive public health awareness campaigns to reduce the impact of noncommunicable diseases, such as obesity or diabetes.
- Address inequality: Invest in equitable healthcare initiatives that reduce disparities in urban underserved populations.
Final Thoughts on Rural and Urban Healthcare
Rural and urban healthcare systems may face entirely different sets of challenges, but their shared goal is to deliver quality, accessible care to their patients and communities. While rural areas grapple with provider shortages and geographic barriers, urban areas must address issues like overcrowding and inequality.
No system is perfect, but understanding the distinctions lets healthcare leaders better address gaps in care and advocate for meaningful change.
If you’re a practice administrator looking to improve access to healthcare in rural areas or urban clinics, start by leveraging innovative solutions and policies tailored to your community’s needs.
Want more insights? Download The Definitive Guide to Rural Healthcare with ideas and options for rural healthcare providers and administrators.
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Sources
1 JAMA, Trends in Travel Time to Obtain Surgical Care for Rural Patients, Cody Lendon Mullens, MD, MPH, Reagan A. Collins, BA, Nicholas Kunnath, MS, et al, Feb. 2025, https://jamanetwork.com/journals/jama/fullarticle/2830214
2 NRHA, About NRHA, https://www.ruralhealth.us/about-us/about-rural-health-care
3 USDS, 2024 Edition, Rural America at a Glance, Tracey Farrigan, Brandon Genetin, Austin Sanders, John Pender, Kelsey L. Thomas, Richelle Winkler, and John Cromartie, Nov. 2024, https://ers.usda.gov/sites/default/files/_laserfiche/publications/110351/EIB-282.pdf
4 USDA 2024 Edition Rural America At a Glance, Tracey Farrigan, Brandon Genetin, Austin Sanders, John Pender, Kelsey L. Thomas, Richelle Winkler, and John Cromartie, Nov. 2024, https://www.cdc.gov/rural-health/php/about/index.html
5 United States Census Bureau, A Glance at the Age Structure and Labor Force Participation of Rural America, Dec. 2016, https://www.census.gov/newsroom/blogs/random-samplings/2016/12/a_glance_at_the_age.html
6 Pew Research Center, How far Americans live from the closest hospital differs by community type, Onyi Lam, Brian Broderick, and Skye Toor, Dec. 2018, https://www.pewresearch.org/short-reads/2018/12/12/how-far-americans-live-from-the-closest-hospital-differs-by-community-type/
7 KFF, Key Facts about Hospitals, Zachary Levinson, Scott Hulver, Jamie Godwin, and Tricia Neuman, Feb. 2026, https://www.kff.org/health-costs/key-facts-about-hospitals/?entry=the-hospital-industry-openings-and-closings
Last updated November 2025
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