Mental health in rural America: Barriers to care

Equity in healthcare series – part 8

Mental health has been gaining attention in recent years, but for many Americans living in rural communities, access to care remains limited. Resources are often concentrated in urban centers, leaving rural residents with fewer options to get the help they need. A mix of geographic isolation, provider shortages, limited transportation, and persistent stigma contribute to significant disparities in mental healthcare access and outcomes.

Rural mental health by the numbers

The data paints a stark picture. According to the National Alliance on Mental Illness (NAMI), people in rural areas experience higher rates of depression and suicide compared to those in urban areas. According to the CDC, between 2000 and 2020, suicide rates in rural communities rose by 46%, while metro areas saw a 27.3% increase. Farmers are particularly vulnerable. Studies from the National Rural Health Association show they are 3.5 times more likely to die by suicide than the general population.

One key challenge: provider shortages. Approximately half of all rural Americans live in a designated mental health professional shortage area. A recent report found:

• 81% have no psychiatric nurse practitioner
• 65% of rural counties lack a single psychiatrist
• 47% have no psychologist

The burden of distance and cost

With limited local providers, many rural residents must travel long distances to access care. A 2021 study found the average travel time was:

• 26.2 minutes to any mental healthcare facility
• 51.7 minutes to an inpatient facility
• 64.3 minutes to an outpatient facility

Lack of public transportation adds to the burden, especially for individuals without a driver’s license or reliable vehicle.

Insurance coverage is another barrier. Roughly 19% of rural residents under age 65 are uninsured, compared to 16% in metro areas. And those who are insured often face higher out-of-pocket costs (29% versus 23% in cities), creating an additional obstacle to seeking consistent care.

The telehealth divide

While telehealth holds promise for rural mental health access, many residents face a digital divide. Roughly 30% of rural Americans lack home internet access. Others may not own a computer, tablet, or smartphone, which are essential tools for telehealth services.

The role of stigma

Stigma surrounding mental illness remains deeply rooted in many rural communities. Mental health conditions are often misunderstood or seen as a personal weakness, and seeking help can be viewed as shameful. This stigma discourages individuals from accessing the care they need.

Rural solutions in action

Despite these challenges, states and organizations are taking action to improve access and support:

• Agristress Helpline®: Launched in 2022, this 24/7 crisis support hotline serves agricultural communities in 11 states, including Texas, Colorado, and Pennsylvania.
• Montana: Mobile crisis response teams now partner with law enforcement to provide on-site mental health evaluations and treatment, especially vital in a state with one of the highest suicide rates and lowest access to care.
• Colorado: Senate Bill 55, passed in 2024, expands mental and behavioral health services for rural and agricultural populations.
• Louisiana: Southern University’s Agricultural Research and Extension Center offers free teletherapy to rural residents across the state.
• Iowa: House File 2673, signed in 2024, streamlines mental healthcare services to promote equal access statewide.
• Alaska: The Center for Alaska Native Health Research launched community-based programs focused on building resilience and protective factors.
• Texas: In March 2025, the Texas Health and Human Services Commission announced $239 million in grants to expand mental health facilities for acute psychiatric care in four underserved communities.
• Hawaii: The Culturally Based Community Connections for Resilience project addresses suicide risk by fostering stronger community ties.

Final thoughts

While the mental health challenges facing rural America are complex, change is underway. Expanding resources, embracing telehealth, and fighting stigma are all critical steps toward equitable mental healthcare no matter where you live. The more communities invest in innovative, inclusive solutions, the more lives we can support and save.

Further reading

• Pharmacy deserts: A growing problem in the U.S.
• Exploring underrepresentation in clinical trials
• A shift in language: How healthcare is tackling stigma

References

• Suicide in Rural America. Centers for Disease Control and Prevention.
• Wilson, Cassidy. Helping farmers who struggle with mental health.
• Winton, Jeff. Confronting Mental Health Challenges in Rural America.
• Negaro, Sophia N.D., Hantman, Rachel M., Probst, Janice C., Crouch, Elizabeth J., Odahowski, Cassie L., Andrews, Christina M., and Hung, Peiyin. Geographic variations in driving time to US mental health care, digital access to technology, and household crowdedness.
• Morales, Dawn A., Barksdale, Crystal L., and Beckel-Mitchener, Andrea C. A call to action to address rural mental health disparities.
• Rural and Urban Health. Georgetown University.
• Graves, Janessa M., Abshire, Demetrius A., Amiri, Solmaz, and Mackelprang, Jessica L. Disparities in Technology and Broadband Internet Access across Rurality: Implications for Health and Education.
• AgriStress Helpline®. Crisis Support for Agricultural Communities.
• Vanh, Hevenn. Park County combatting mental health concerns with mobile crisis response team.
• Someone to Respond—Mobile Crisis Services.
• Ashby, Charles. Bill aims to provide mental health care to ag workers.
• Woods, Dominique. Free virtual mental health services for Louisiana residents in rural areas.
• Evans, Sarah, and Ng, Natalie. A rural Iowa county grapples with an overworked mental health care system.
• Kapelow, Brandon. Native-led suicide prevention program focused on building community strengths.
• Sheffield, Baileigh. Governor Abbott announces $239 million in grants to expand mental health care access in rural Texas.
• UH, Health Dept. aim to prevent suicide in high-risk groups.

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