Approximately 19% of the population (61 million people) and 86% of the country’s land area are considered rural. Yet, philanthropy often overlooks these communities – they receive just 7% of all philanthropic giving -- despite the vast health inequities and challenges that exist.

When compared to urban residents, rural residents have higher rates of poverty, food insecurity, and healthcare provider shortages. Rural residents are more likely to be unemployed or underemployed, lack private insurance, and reside in substandard housing. When we dig a little deeper, research reveals that rural BIPOC communities experience higher rates of obesity and poverty and lower educational attainment than white people in rural areas and all races in urban locations. Meanwhile, the healthcare system designed to support these rural communities remains under-resourced. Nearly 61 million rural residents are cared for by a network of fewer than 1,700 hospitals, less than 9,000 rural community health centers and certified Rural Health Clinics, and only a few thousand health departments (excluding charity care, tribal, or Indian Health Service). Rural local health departments are more likely to provide direct clinical (and more complex) care, offering everything from immunizations to maternal services to meet the gaps in access.

The Federal Office of Rural Health Policy (FORHP) within the Health Resources and Services Administration (HRSA) recognized that rural health stakeholders needed support, but not in a top-down approach. States needed the flexibility to address their most pressing needs, with an infrastructure to link rural communities with state and federal resources. In 1995, Congress authorized the State Office of Rural Health (SORH) program as a unique partnership between federal and state governments. This matching program of three state dollars for each federal dollar places a greater emphasis on state direction and investment.

All 50 states have a SORH. Each SORH is part of either a state government, academic institution, or independent nonprofit based on their state’s gubernatorial designation. From offices of one to offices greater than 50, SORH leverage their state and federal connections to support the health and wellbeing of rural communities. The SORH program has three general goals:

  1. to support rural communities with information collection and dissemination,
  2. coordinate rural health activities to reduce duplication, and
  3. provide rural communities with technical assistance in identifying and connecting to state and federal programs.

SORH provide a single point of contact in their state for rural health programs, allowing for a feedback loop between the local, state, national, and federal levels. When a rural community reaches out, the SORH may provide direct technical assistance or connect them with a partnering organization with the expertise needed. They may even link them to existing promising practices and toolkits.

But SORH can’t do this work alone; collaboration is the key to success in rural. To support the efforts of the SORH and their stakeholders to improve the health of rural America, the National Organization of State Offices of Rural Health (NOSORH) was established as the nonprofit membership association. NOSORH enhances the capacity of SORH and their stakeholders by facilitating state and national partnerships and providing vital leadership development, advocacy and education.

Despite the challenges, rural communities are resilient, resourceful, and innovative. Some of the greatest innovations are born from the need to share limited resources. These communities recognize the importance of bringing every sector to the table, not where one is more important than the other – but where each partner has a responsibility and an equal voice.

For example, Loretta Webb Wilson, founder and director of Rural Alabama Prevention Center, is regarded as a passionate community leader and convener. Working to bridge health disparities and improve outcomes in the state’s poorest communities in Alabama’s Black Belt, she formed a team in collaboration with multiple organizations, agencies, and institutions, bringing COVID-19 education, testing, and vaccinations to places where it mattered most. The results of her efforts are found in CDC data -- eight of Alabama’s top 10 most-vaccinated counties are in the Black Belt.

National Rural Health Day: How Donors Can Take Action

Recognizing the importance of telling the positive side of the rural story, NOSORH founded National Rural Health Day (NRHD) as an opportunity to “celebrate the Power of Rural” and bring much-needed attention to the incredible efforts of rural health providers, coalitions, SORH and other rural stakeholders in addressing the unique needs of rural communities. Over the years, NOSORH has transformed this single day of recognition into a year-long #PowerOfRural movement, with the potential for broader media attention, partner engagement, collaboration and national recognition by rural stakeholders and decision-makers.

As philanthropic partners begin making greater investments in the health and wellbeing of rural communities, we encourage you to collaborate with SORH and NOSORH on your efforts and get involved in NRHD. We can be a conduit for information sharing, a linkage between community needs and funder priorities, or possibly a funded partner. There are tremendous opportunities for philanthropic partners to drive the #PowerofRural forward, investing in rural communities and people, alongside SORH, as we build a healthy, prosperous rural America.

To learn more about NOSORH and connect with your state's SORH, visit To learn more about National Rural Health Day (Nov. 17, 2022), visit Join the rural health conversation on social media with the hashtag - #PowerOfRural.