Make Rural America Healthy Again? Crawling Before Walking and Running.

Why Rural Healthcare Must Be Built on Strong Foundations Before We Chase Big Promises.

The headlines announced by HHS Secretary Kennedy at the end of 2025 dangle a promise of revolutionary change for rural healthcare, especially with billions of dollars to be awarded to all 50 states through a CMS Rural Healthcare Transformation Program under the direction of Dr. Mehmet Oz. But was there ever a time when Rural America was actually healthy and well? Will telemedicine solve access problems to high-quality care? Will mobile clinics reach every community? Will AI-powered diagnostics level the playing field between rural hospitals and urban medical centers? These are compelling visions, and some may eventually materialize. But they're putting the cart before the horse, and rural Americans are paying the price for the federal government's collective impatience.

The federal government needs to stop chasing transformative solutions to "Make Rural America Healthy Again" and start addressing the fundamental crisis staring us in the face: rural America lacks the basic infrastructure to deliver comprehensive, high-quality essential healthcare services. Before running toward an innovative future, we need to learn to crawl—building the foundational elements that create resilient, sustainable healthcare systems capable of serving rural communities for the long haul.

The Unsexy Truth About Rural Healthcare.

Here's what doesn't make for good mass media communication: rural healthcare is failing because of everyday problems. Not enough doctors. Crumbling facilities. Inadequate broadband. Insufficient funding for basic operations. Emergency departments closing because they can't staff overnight shifts. Patients driving two hours for routine care because the local clinic shut down.

These aren't problems that require genius-level innovation. Although, The Trump administration would have Americans believe that it does. What is really required?  Resources, political will, and the patience to do boring, laborious foundational work over many years. But that's not what we want to hear. We want moonshots. We want disruption. We want to believe that technology or market forces or bold new public health policies will suddenly fix everything without the hard work of rebuilding broken healthcare systems brick by brick.

The result? We've spent two decades watching rural hospitals close at an accelerating rate while simultaneously celebrating pilot programs that will supposedly revolutionize care delivery. We've championed telemedicine as a panacea while ignoring that many rural areas still lack reliable internet access. We've talked endlessly about recruiting physicians to underserved areas while making medical education so expensive that new doctors are forced to chase high-paying specialties in urban centers just to manage their debt.

What Crawling Actually Looks Like.

If the feds are serious about making rural America healthy, there needs to be a solid commitment to the unglamorous work of building foundations. This means:

1.      Stabilizing what we have left. Before we build new models of care, we need to stop the hemorrhaging. Rural hospitals need sustainable funding models that don't punish them for serving older, sicker, poorer populations. This might mean expanding Medicaid in holdout states, revising Medicare reimbursement formulas, or creating dedicated federal funding streams. It definitely means abandoning the fantasy that rural hospitals can operate like businesses in a free market. They can't, and they never will. Healthcare in sparsely populated areas requires subsidy, full stop.

2.      Fixing the pipeline problem. We cannot technology our way out of a healthcare workforce shortage. We need more doctors, nurses, paramedics, allied health professionals, and mental health providers willing to practice in rural areas. This requires making medical education affordable, creating meaningful loan forgiveness programs, and investing in rural-focused training programs that produce providers who actually want to stay in these communities. It also means being honest that we may need to expand scope-of-practice laws to let nurse practitioners and physician assistants do more, because we're simply not going to have enough primary care physicians to go around.

3.      Building the basics of modern infrastructure. You cannot deliver 21st-century essential healthcare services over 20th-century infrastructure. Rural communities need reliable broadband, upgraded facilities, modern technology, and functional supply chains. Before we talk about AI diagnostics and remote surgery, we need to ensure that rural emergency rooms have working CT scanners and that ambulances don't have to drive over an hour to find the nearest trauma center.

4.      Creating realistic timelines. Healthcare infrastructure doesn't change overnight. Even with unlimited resources, it takes years to train a doctor, a decade to change practice patterns, and a generation to rebuild institutional trust. We need to accept that fixing rural healthcare is a 20-year project minimum, and stop expecting miracle cures or declaring victory after a promising five -year pilot program.

Why This Matters Now.

The stakes have never been higher. Rural populations are older and sicker than urban populations, with higher rates of chronic disease, opioid addiction, and mental health crises. They're dying younger from preventable causes. They're being hollowed out by population loss, partly because families with children can't risk living somewhere without access to basic healthcare.

This isn't just a rural problem. It's a national vulnerability. When rural healthcare systems collapse, they don't just affect farmers and small-town residents. They affect everyone who depends on the food, energy, and infrastructure that rural America provides. They affect our national security, our supply chains, and our social fabric.

The Political Will Problem.

The hard truth is that fixing rural healthcare requires political courage that seems to be in short supply. It requires blue state politicians to support programs that will disproportionately benefit red states. It requires red state politicians to accept federal intervention and funding that conflicts with their small-government ideology. It requires both parties to prioritize long-term investments over quick wins that can be touted in the next election cycle.

It also requires rural communities themselves to make hard choices. Some small hospitals may need to close or transform into urgent care centers. Some towns may need to consolidate services. Some communities may need to accept that they'll never have a full-service hospital 10 minutes away. These are painful conversations that many communities have been avoiding.

What Success Actually Looks Like.

Making rural America healthy again won't look like a revolution. It will look like slow, steady progress. A hospital that was on the brink of closure stabilizes its finances. A community that lost its only primary care doctor recruits two nurse practitioners. A region that had no mental health services establishes a telepsychiatry program backed by real broadband infrastructure and local care coordinators. An ambulance service that was down to one part-time crew expands to 24/7 coverage.

These victories won't generate headlines. They won't disrupt anything. They'll just save lives, improve quality of life, and give rural communities a fighting chance to thrive.

The Path Forward.

We know how to do this. Other developed countries have figured out how to deliver quality healthcare to rural populations. It requires treating healthcare as a public good rather than a market commodity. It requires sustained funding. It requires patience. And it requires letting go of the fantasy that we can skip straight to the exciting stuff without doing the boring foundational work.

The question isn't whether we know what to do. It's whether we have the political will, the financial commitment, and the humility and empathy to do it. Are we willing to crawl before we walk? Are we ready to spend years rebuilding before we chase transformative innovation?

Because if we're not, we should stop pretending we're serious about making rural America healthy. We should admit that we're more interested in feeling good about big ideas than in doing the hard work of actually fixing the problem.

Rural Americans deserve better. They deserve leaders and policymakers who are willing to show up, do the boring work, and stick around long enough to see real results. They deserve a healthcare system built on solid foundations rather than inspiring promises.

It's time to get crawling!