Rural America has been left out of the economic boom that is heralded regularly in newspaper
headlines and political campaigns. Not only is this true of agricultural communities where, for
example, one recent account asserted that in one four county consolidated school in eastern Iowa,
there was an effort to buy hams to distribute to those people who had been getting food from the
local food pantries. The school has 102 children, 75 of them qualify for the school food
assistance program.

____Poverty in rural America is often unseen, unacknowledged, unattended.
Currently the U. S. government bases its determination of the "poverty line" as the amount of
income needed to purchase a minimally adequate basket of goods and services. (Utilities,
clothing, food) In actuality, the market basket was based in effect on one commodity—food. The
formula assumes that poor families spend one-third of their income on food, and therefore the
cost of a minimally adequate diet was multiplied by three to arrive at the income poverty
threshold. Thus, it might appear confusing to urbanites to realize that rural areas, seen as places
for food production, have a poverty rate based largely on food needs. In the film, "A Farmer’s
Wife," for example, it was shocking to many urban viewers that the family of farmers got their
food from programs for the poor, rather than from their own gardens. The poverty line is based
upon food, and many rural areas suffer from its lack.

____The U. S. Bureau of the Census uses this measure of poverty in order to assess the
number of poor people. The federal Office of Management and Budget uses it to set the
eligibility standards for federally funded income maintenance programs. In 1996, the poverty
line was $15,911 for a family of two adults and two children, $10,815 for a family of one adult
and one child, and $8,163 for a single individual.

____More than 51 million Americans live in areas classified by the U.S. Office of
Management and Budget (OMB) as nonmetropolitan. They comprise one-fifth of the U.S.
population. Rural populations are found to be older, poorer, sicker, less educated and to have a
perception of worse health status than their urban counterparts. They also have higher infant
mortality and injury-related mortality rates, fewer hospital beds and physicians per capita, and
are much less likely than urban residents to have private or public health insurance. The rate of
uninsured is more than 20 percent higher in rural areas than in urban areas. Fewer rural people
enroll in Medicaid. States in the Southwest and Southeast have the highest percentage of
uninsured people.
____Health care across the United States in rural areas has its own special problems. Take
Medicare reimbursements to rural hospitals for example. Unlike our urban relatives and friends,
most rural residents and Medicare and Medicaid beneficiaries do not have the option to choose
another health care provider or to travel a short distance to seek health care services when those
in their own community have been eliminated. Under the Balanced Budget Act of 1997, the
amount of money that rural hospitals and other health care providers for their services to elderly
and poor beneficiaries were reduced—the cost of equipment though, was the same, the
reimbursements available were lessened. This had a chilling impact on the availability of
resources and services. Legislators had the misconception that rural areas needed the services
less, and the practice was that there were many that did not avail themselves of such services or
did not know that they were available. What’s not used or known about was cut. But a lack of
knowledge could be remedied by information. A lack of utilization could be overcome by
adequate education and a provision of services customized to the culture or rural poor people.
Rather than cut, what should have happened was more intense research to find ways to meet
existent need, to supply transportation, information in community institutions.

____For years rural hospitals have been confronted with one obstacle after another. Hundreds
have closed. Rural health care is significantly at risk. Rural doctors derive a larger share of their
gross practice income from Medicare and Medicaid patients than urban physicians. These public
programs pay physicians at lower rates than private insurers. Rural hospitals have fewer
opportunities to perform procedures that would be economically enhancing (obstetrical or
surgical units, etc.) which further decreases relative reimbursement rates. Rural physicians on
average, work more and earn less than their urban counterparts. The needs of spouses and
children factor into the recruitment process for doctors in rural areas. Professional isolation is
often cited as a reason to leave rural areas.

____Less than 11 percent of the nation’s physicians are practicing in rural areas. Providers in a
small rural community usually do not have the option of refusing care to anyone, thus leading to
potential bankruptcies. Where small hospitals are becoming linked to networks of hospitals and
increasing managed care pressure to contain costs and achieve quality assurance standards, rural
hospitals increasingly find themselves with less ability to provide uncompensated care.

____Also, by contrast with America’s recent economic boom, rural areas provide fewer job
opportunities and options than urban areas, with the types of jobs offered tending to be part time
and minimum wage. Low-population densities in rural areas hinder the development of
workplace supports and infrastructure (education and training, childcare, public transportation).
And fewer "safety net service," special health care, shelters and soup kitchens are available in
rural areas. Rural economic development tends to be one variant or another of "elephant
hunting." Large scale, low wage employees are sought out by state economic development
services, including prisons, toxic waste dumps, huge animal confinement units for raising or
processing hogs, poultry or turkeys. Another growing rural based enterprise is the casino. Rather
than do economic development that considers the actual community, its assets, capacity, and
potential, states seek enterprises which provide large scale and quick opportunities. So, pigs,
poker and prisons make up three leading economic enterprises for rural development.

____Areas of persistent poverty in rural America deserve particular attention. Appalachia, the
Delta, the lower Rio Grande, and Indian Reservations are all areas of persistent poverty. For 535
counties in the United States, poverty continues to be a long term problem in rural counties with
20% or more of their population living below the poverty level in each of the years 1960, 1970,
1980, 1990. The rural average of 18.3% shifts in these counties considered one at a time from
20% to 63% with an average of 29%. These counties are heavily concentrated in the Southeast,
Appalachia, and the Southwest, with others scattered on Native American reservations in the
North and the West. The persistent poverty counties (24% of all nonmetro counties) contain 19
percent of the nonmetro population and 32% of the nonmetro poor (2.7 million). Poverty
counties have disproportionate numbers of people with characteristics that make them prone to
economic disadvantage. On average, these counties have large numbers of people without a high
school education putting them at risk of being unprepared to participate in the economy and
people living in female-headed households. These counties also have higher than nonmetro
average proportions of Blacks and Hispanics, groups that have historically had trouble gaining
access to economic opportunities. Poverty is not, however, strictly a racial issue. As noted
above, education and family status are important factors. Furthermore, nearly 80% of the
nonmetro poor, are, in fact, White. In poverty counties that figure is 56%. Given their share
of the population, however, Blacks and Hispanics do make up a disproportionate share of the poor
in poverty counties and in nonmetro counties as a whole.

____Nonmetropolitan areas account for only 3% of the U. S. labor force growth despite
representing 19% of the U. S. Population. Rural residents are more likely to reach time limits
sooner than their urban counterparts. With the personal responsibility and Work Opportunities
Act (HR 3734) poverty programs are moved from a federal safetynet to state directed efforts
focused on actively moving individuals from "welfare to work." However implementing these
programs holds particular implications for rural areas where poverty rates are higher, those living
below the poverty line are more likely to be already employed, and local governments possess
fewer resources.

____Overall, poverty rates in rural areas have been and continue to be consistently higher than
those found in urban areas, which includes inner cities. In 1990, there were 9 million in rural
areas living in poverty; nearly one in five rural residents. The overwhelming majority of these
rural poor were white (72.9 percent). In 1993 in the North Central region, the rural poverty rate
stood at 13.6% whereas the poverty rate for urban areas was only 11.4%. The poverty of rural
areas is distinctively different from urban areas. Rural areas not only have consistently higher
rates of poverty than urban places, but those living in rural areas are more likely to be white and
living in two-adult households. As indicated above rural areas also have higher rates of
persistent poverty and they are dispersed over a larger geographic area. Compared to their urban
counterparts, those living in poverty in rural areas are more likely to be working. These are the
"working poor." The majority of those living in poverty do not get government welfare
assistance. Participation rates in social service programs in rural areas are lower than urban areas,
in rural areas only one-quarter of the income of adults living in poverty get assistance.

____Homelessness in rural areas is often overlooked as a problem because it is thought of as
an urban issue. An accurate count is difficult and estimates range from 6.9% (Census 1992) to
18% (NRHA 1996.3) of the total homeless population. Shelters are a rarity in rural areas—some
people double up with other families, others live in abandoned homes, and some live in their
vehicles at camp grounds. Research suggests that the homeless in rural areas are more likely to
be white, to be working, and to be two parent families.

____Rural poverty, then, is not one problem---it is many. Many Native Americans living in
rural areas are poor, but their problems are very different from the poor in rural Appalachia.
And the Black people living in the Mississippi Delta have different issues to confront then do
those in either of the other rural places. This is one facet of the fundamental defining
characteristic of rural America, it is diverse and different from one place to another. The
landscapes provide a good orientation to those differences. Compare the open fields of the Plains
to the forested and rocky areas of New England, the deserts of California and New Mexico to the
estuaries of Florida and Louisiana. The rural landscapes provide varying potential for economic
life, social and cultural life. Geography and culture, isolation and low population density provide
their own challenges.

____Hand in hand with the poverty in rural America is a lack of basic necessities such as
health care, good nutrition, education, and essential public services. Improvements in these basic
necessities are essential if people in these counties are to be healthy, educated, productive
workers. One significant area of contemporary challenge is the lack of internet and
communications services. The digital divide is a real problem in rural communities.

____Nine million rural people in the United States live in poverty. This large amount of the
population has generally been overlooked even as considerable attention and social conscience is
directed to the alleviation of urban poverty. Rural poverty is not confined to one section of the
country or one ethnic group. Rural poverty reveals itself in a variety of ways.

____Food bank distribution in rural areas has grown since the implementation of federal
welfare reform in 1997. Food bank administrators emphasized that the data on pounds distributed
(increase in every case) does not accurately reflect need. They state that need in distressed areas
always far outstrips supply which is limited by the normal fees that food banks charge counties
for food and the cost of transportation.

____A comparison of urban and rural children shows marked differences in their socio-
economic wellbeing, region of residence, and racial/ethnic background. The poverty rate for
rural children was 24% compared with 22 percent for urban children. The poverty rate in the
South and West for rural children was about 30%. The share of rural children in the South was
43 percent (compared to 32 percent urban). In the Midwest a much larger share of rural children
(30%l) compared to urban children (22%) Where children live makes a difference in the services
and support available to their families, the job opportunities may be more limited in some areas
than others. In minorities—poverty rates for rural minority children are much higher than for
rural White children.

____Rural Black children’s poverty rates were the highest (50%), while Hispanic and Native
American poverty rates exceeded 40%. Severe poverty (family income below 50% of the poverty
level) for minority children was disproportionately high. Rural minority children tend to be
concentrated regionally. Rural minority children tend to be concentrated regionally. About 89
percent of rural Black children livening in the south were poor, compared with 19 percent of
rural White children in the South. Forty nine percent of rural Hispanic children living in the West
and 46% of rural Hispanic children living in the South were poor.

____Rural health care should be at the very top of the agenda for rural America. Funding
levels need to be increased to support rural health clinics, hospitals, and services for mental
health. Medicare and Medicaid need to be organized with specific attention to rural conditions
and rural culture. A one size fits all approach is not adequate. Our country has enough
appreciation for diversity to recognize that rural cultures and communities are very diverse and
need some tailor-made attentiveness. The same is true for welfare to work programs.
Transportation, daycare, the limitations of opportunity for work, the lack of adequate educational
services for training, the problem of the lack of internet capacity (so called, digital divide). Each
of these issues seem not beyond the ken or capacity of our government to approach. There are
creative programs in rural America which deserve emulation. In Athens, Ohio, Acenet, (Ap-
palachian Center for Economic Networks) a microenterprise operation in Appalachia is
providing co-operative opportunities for small scale cottage industries, for special brands of food
products using local shared kitchens. In Abingdon, Virginia, a creative opportunity for housing
the elderly poor called Elder-Spirit is uses a creative notion called "co-housing" where elderly
poor are provided dwellings in a village like setting affixed to larger family homes. In northern
New Hampshire, women have a co-operative resource center for work discovery and
identification called "WREN" (Womens Rural Economic Network). There are creative efforts in
rural areas to assist with a range of issues. The models are being developed, the government
needs to emulate and to fund some of these local efforts.

____Rural America is not exclusively the idyllic portrait so many viewers of paintings by
Grandma Moses, Norman Rockwell, Grant Wood or Georgia O’Keeffe appreciate. It has a large
share of poverty and difficulty, some of it for long periods of time with little appreciable
improvements. We do well both to recognize rural poverty and work for its elimination.
Creativity in designing programs and for providing funding is needed. But first we have to
recognize the facts. We do well then, not to ignore rural poverty when times appear so profitable
for many in other locations.


Recommended Readings:

____Duncan, Cynthia (1999) Worlds Apart: Why Poverty Persists in Rural America.
New Haven, CN: Yale.

____Fichten, Janet (1991) Endangered Spaces, Enduring Places: Change, Identity and
Survival in Rural America. Boulder, CO: Westview.

____Fichten, Janet (1981) Poverty in Rural America: A Case Study. Boulder, CO: Westview.

____Rural Sociological Society Task Force on Persistent Rural Poverty (1993) Persistent
Poverty in Rural America. Boulder, CO: Westview.