Catching up on rural healthcare stories

I wrote several posts about rural healthcare this summer, mostly prompted by the consideration and passage of Trump's One Big Beautiful Bill, which was widely discussed as undermining rural health care and rural hospitals.  Since then, I've neglected the issues except to address some of them in this forthcoming law review article, which focuses on the challenge of maternal mortality for rural women.  

In this post, my plan is just to provide links to the stories I've seen about rural health care since the summer, making this something of a repository of resources to study how rural health care is faring in the Trump administration's first year and likely further degradation of services as a consequence of recent Republican policies.

First off, the Trump administration is withholding support to tsunami proof this hospital.  Katia Riddle reports from Astoria, Oregon.   One interesting aspect of this story is how local Republicans who supported Trump are flummoxed--or worse--about his administration's failure to support a rural hospital that has saved many local lives.  Here's some context:   

The Trump administration has canceled billions of dollars in federal grants across multiple agencies, and one of those grants is for a program that was designed to help local governments fortify places that are vulnerable to natural disasters.

* * *  

[The hospital in Astoria], called Columbia Memorial, was built decades ago. Now that we know more about earthquakes, it's hard to imagine a worse spot to build a hospital. Not only is the whole town in a major subduction zone, the building is just a few blocks from the water, on top of dangerously unstable ground.

And here's a key quote from a former mayor of Astoria, Willis Van Dusen, a Republican who voted for Trump but now is frustrated by the recent turn of events regarding the needed hospital work: 

Van Dusen: What is more important than a hospital in a rural community like Astoria? Now, it saved my life.

Riddle: Van Dusen points to a framed photocopy of a piece of paper - the EKG reading when he had a heart attack some years ago. At one point, he flatlined.

Van Dusen: All these are (imitating electric current), and they're hitting the paddles. And I had actually died.

Riddle: It was doctors at Columbia Memorial that brought him back. Van Dusen says he and many other people in Astoria wouldn't be here without this hospital. Making sure that it can keep providing care during an earthquake and a tsunami, he says, is the opposite of waste, fraud and abuse.

Van Dusen: And just to jerk that money away from us, I can't just say it makes - it's frustrating. It makes me livid. It makes me angry.

Riddle: Van Dusen says he's not the only one in this town who's mad.

Van Dusen: I know every single Republican that I have talked to is livid over what's happening.

This is a rare instance when I've seen a Trump voter whose mind has been changed by Trump's spending priorities--and how those priorities have played out in the voter's own community.  It shows that Trump voters can be swayed when Trump's spending priorities impact them, something rarely illustrated.  

Regarding the $50 billion "rural health fund," sometimes referred to as the rural slush fund, Sarah Jane Tribble of Kaiser Health News reported about ten days ago on how states are competing for these funds.  It hardly seems like a fair fight.   Tribble provides details on how and why substantial chunks of the funds might not even wind up in rural places:  

Nationwide, states are racing to win their share of a new $50 billion rural health fund. But helping rural hospitals, as originally envisioned, is quickly becoming a quaint idea.

Rather, states should submit applications that "rebuild and reshape" how health care is delivered in rural communities, Centers for Medicare & Medicaid Services official Abe Sutton said late last month during a daylong meeting at D.C.'s Watergate Hotel. Simply changing the way government pays hospitals has been tried and has failed, Sutton told the audience of more than 40 governors' office staffers and state health agency leaders — some from as far away as Hawaii.

"This isn't a backfill of operating budgets," said Sutton, CMS' innovation director. "We've been really clear on that."

Rural hospitals and clinics nationwide face a looming financial catastrophe, with President Trump's massive tax-and-spending law expected to slash federal Medicaid spending on health care in rural areas by $137 billion over 10 years. Congressional Republicans added the one-time, five-year Rural Health Transformation Program as a last-minute sweetener to win the support of conservative holdouts who worried about the bill's financial fallout for rural hospitals.

Yet, the words used by CMS Administrator Mehmet Oz and his agency's leaders to describe the new pot of cash are generating tension between legacy hospital and clinic providers and new technology-focused companies stepping in to offer new ways to deliver health care.

It's "what I would call incumbents versus insurgents in the rural space," said Kody Kinsley, a senior policy adviser at the Institute for Policy Solutions at the Johns Hopkins School of Nursing.

I further detail possible non-rural uses of the fund in my forthcoming law review article, which relies on Tribble's reporting. 

Finally, Abigail Ruhman reported for the Texas Tribune a few weeks ago on how Texas' rural hospitals are competing for a piece of that "rural slush fund."  

As Texas develops its application for a new rural health funding program, rural hospital leaders say the priority should be financial stabilization for their facilities.

The recent sweeping tax and spending plan includes a $50 billion appropriation for the Rural Health Transformation program. States will receive funding based on applications they submit in early November.

During an hours-long public hearing Monday to discuss the program, several hospital leaders raised concerns that without direct funding, the state may experience more rural hospital closures.

Erin Clevenger, CEO of Memorial Medical Center in Port Lavaca, southeast of Victoria, said her hospital is high on the list of Texas hospitals at risk of closure.

“Every day is a battle to make sure we don’t become one of those statistics,” Clevenger said.

In the last decade, Texas has lost 14 rural hospitals. Of the 156 rural hospitals currently in the state, about 70% have lost services, and more than half are at risk of closing, according to a report from the Center for Healthcare Quality and Payment Reform.

Memorial Medical Center is in the southern part of the state, but it provides critical services that benefit people across Texas – even patients in Dallas.

“When even large urban hospitals could not take on more patients, we opened a COVID care unit and accepted their transfers, even flying patients in from Houston and Dallas,” Clevenger said.

Keep an eye out for more news about whether rural hospitals are getting the benefit of the "Big Beautiful Bill" and its rural slush fund--and whether any funds they receive are sufficient to keep them open.  It'll also be interesting to see if the anticipated closure of rural hospitals will turn rural Trump supporters against him--if those closures happen during his presidency.  

Meanwhile, the reduction and reinterpretation of other federal funding streams, along with other strains,  have been threatening--and in one instance, closing--hospitals in rural California.  Read more here (Inyo County in the eastern Sierra) and here (Imperial/Riverside County).  

New immigration fee will hurt rural schools relying on international teachers

Sequoia Carrillo reported from Hardin, Montana for NPR on a school system's heavy reliance on teachers from the Philippines and what that reliance means given the new Trump administration rule requiring a $100,000 fee for each H-1B visa application.  Here's an excerpt from Carrillo's story:  

Hardin, like many rural districts, relies on international teachers to fill out its staff. Out of 150 teachers in the district, about 30 are in the U.S. on teaching visas. Many are on short-term J1 visas, with hopes to one day graduate to the longer-term H-1B visa.

Now, things are about to get even tougher — for the district and for teachers like Tomimbang [who has taught middle school math in Montana for four years after doing so for 18 years in the Philippines]..

Last month, President Trump unveiled a plan that requires employers pay a $100,000 fee for new H-1B visas. In his announcement, Trump specifically called out high-paying tech jobs that he said were filled by too many foreign workers.

However, the impact on schools and educators will be significant. According to data from the Department of Homeland Security, more than 20,000 educators are in the country on H-1B visas — the third most common occupation group for the program.

"I don't have a teacher in my district that makes $100,000 a year," [Hardin school superintendent Tobin] Novasio says. For school districts, "to pay that fee on top of a salary is just gonna kill the H-1B for education."

The change is a blow to some districts' long-term strategy to keep teachers in classrooms.

More relevant context fron superintendent Novasio:  

"We don't have candidates." ... Earlier in his career, [Novasio] says that if he posted an elementary teacher position, at least 20 people would apply. Now, "if we get two, we're ecstatic."

An unduly provocative headline from the Ezra Klein Show about rural-urban tension

Image from today's New York Times Ezra Klein Show podcast.

The headline for the Ezra Klein podcast today--the one that popped up on my NYTimes audio feed--is "The Rural Power Behind Trump's Assault on Cities."  I found that very provocative--unhelpfully so.  It seems to place blame on rural America and rural Americans for Trump's assault on urban America.  In fact, it's not only provocative, it's a bit misleading regarding the content of the podcast, which is an interview with Suzanne Mettler about her book, with Trevor Brown, Rural versus Urban:  The Growing Divide that Threatens Democracy (Princeton University Press, 2025).  I'll come back to that, but first I want to excerpt the part of the interview where Klein gets closest to backing up the provocative headline: 

Klein:  

I’ve heard a lot of people who study civil wars say it is a bad sign when the federal government is ordering armed troops from some states into other states over the objections of those states’ governors and — these are all cities they’re ordering them into — those cities’ mayors.

And you can look at this, and I think I have been looking at this, and say: This sure looks like a rural coalition militarily occupying the cities it has come to see as the power centers of their enemies. (emphasis mine)

What I don't understand is how Klein can assert that a "rural coalition" is militarily occupying U.S. cities.  Who makes up this purported "rural coalition," exactly, when there are too few rural voters to have put Trump in the White House?  Klein's assertion completely overlooks the much more robust numbers of urban voters who chose Trump.  (Nicholas Jacobs, co-author of The Rural Voter, has commented on this in various publications, most recently here).  Perhaps Klein is thinking about the disproportionate power of red states in the U.S. Senate and the Electoral College?  If so, he should consider that the rural voters in California and New York are as underrepresented as those states' urban voters--and that "red states" like Idaho and Arkansas have "blue cities" like Boise and Little Rock, whose urban residents are overrepresented.  (I wrote more about this here and here).  

Or is Klein somehow claiming that rural is occupying urban because a disproportionate number of rural young people join the armed services?  whatever Klein means, I see this framing--this attribution of what Trump is doing to a "rural coalition"--as inflammatory and therefore unhelpful.  Of course, it is also inaccurate unless one uses a really capacious definition of "rural."     

Here's Mettler's response to Klein's comment.  Unfortunately, Mettler doesn't actually respond to Klein's assertion that some rural coalition is militarily occupying U.S. cities.  She says:  

Well, it’s unthinkable. It’s so un-American to be telling the military you can use cities as training grounds and to be sending in federal troops and federalized National Guard into cities. And this comes on top of Trump, for the past few years, using a lot of rhetoric against cities — but now using actual violent force against cities.

So how is this possible? It’s possible because of the rural-urban divide. It’s possible because this us-versus-them politics has become so deep.

By the way, the headline for this podcast on the NYT home page right now is a less sensational "How the Democratic Brand Turned Radioactive in Rural America."  Both the provocative and less provocative headlines show up when you click through. 

Here are some of the more interesting exchanges about the book that are featured  in the podcast:

Klein: 

Before we get into what created the divide, beginning in the ’90s, what kept urban and rural America politically united for so long?

Mettler:  

If you go back to, say, the late 19th, early 20th century, as industrialization is happening, rural areas really feel left behind. There’s a big agricultural depression in the 1920s. Then the Great Depression comes. And rural people at that point are really upset, and policymakers are worried there’s about to be a revolution in the countryside, as they call it.

But what happens is that Franklin D. Roosevelt steps in and creates this big rural-urban coalition. And to an extent that I was unaware of until we wrote this book, he really put rural Americans front and center in his vision of what needed to happen for the country and created all of these policies that were really designed to lift up rural America.

Archived clip of Franklin D. Roosevelt: 

I cannot escape the conclusion that one of the essential parts of a national program of restoration must be to restore purchasing power to the farming half of the country. Without this, the wheels of railroads and of factories will not turn.

* * *  

Rural Americans really appreciated that. They felt the Democratic Party was there for them, and many of them remembered it for their lifetimes. And then their kids did, as well, all the way up until the 1990s.

In the 1980s and early ’90s, rural places were more likely to send Democrats to Congress than Republicans. Only a few decades ago, there was still a coalition where there were rural politicians who were really at the forefront in Congress in brokering compromises on all sorts of important policies.

Klein:

In 1964, Lyndon Johnson signed the Civil Rights Act into law. And that kicks off this process of ideological polarization, where the parties sort into liberal and conservative. The Dixiecrats die out.

And I think the most commonly believed story about what happened in the urban-rural divide is that they hated the Civil Rights Act. I think if you look at a lot of Democratic accounts of this, you’ll see something like that.

But you don’t buy that account. Why?

Mettler:

Yes, that’s wrong. So for one thing, just look at when the rural-urban divide emerged: It’s not until the late 1990s.

The story that you’re telling, usually the follow-up is that the South left the Democratic Party. Well, in fact, there were a lot of urban Southerners who left the Democratic Party. But rural Southerners stuck with it up until the 1990s, and then they left.

Klein:  

The way your book is structured, you sort of say: There’s this economic divergence, and then layered on top of that very quickly is what you call elite overreach. That’s what we’re talking about here.

The way you describe it is: “It was not any one issue that tipped the scales but rather the persistent commonality that ran across them. From 2008 onward, rural Americans perceived an urban elite that sought to impose itself on far-flung places, controlling residents’ lives through new rules and procedures, in which they felt they had little voice.”

And you argue that the issue here is not the policy but the sense of respect or disrespect, of listening or not listening, of representation or absence of representation — that there was something sort of beneath policy that drove this.

Klein: 

Political scientists use this slightly strange tool called the feeling thermometer, where they ask people to rate other groups on a 1-to-100 scale.

You have this data for white rural America, and on a scale of 1 to 100, they put Black Americans at a 70 — pretty good; Hispanic Americans at 67; gay men at 57; illegal immigrants at 39 — pretty low; and Democrats at 14 points.

So Democrats are rated at less than half illegal immigrants’ rating.
By the way, this is not just rural America — white urban Democrats put Republicans at 17 points. But the hatred is much more concentrated at the political outgroup, at least in these measures, than at any other group.

Klein:

White rural America’s sense that the Democratic Party sees all these other groups as in need of help and respect and is prioritizing them ahead of them — Arlie Hochschild’s idea about other groups getting to cut in line. And then there’s a real rise of discourse around white privilege. And this creates — we’ve seen this in our politics — a lot of anger.

Like: You’re telling me — in a poor community that has very few jobs now, where life expectancy is going down — that I have white privilege, and your urban coalition is what needs the help? Or that illegal immigrants need the help?

I’d like you to talk a bit about that distinction between the divide being discriminatory, and the divide being a feeling: That coalition doesn’t prioritize me, so I’m going to go with a coalition that does.

Mettler:  

It’s a really important issue in that I think a lot of urban Democrats assume that what’s at play in this rural-urban divide is that rural white people are racist. What we find is that it’s not reducible to that.  (emphasis mine)

The way we understand it is that it’s in this same period that there’s the sense of elite overreach on the part of Democrats, where rural Americans are looking at the Democratic Party and thinking: They don’t understand us. They don’t care about our communities.

And on this, they’re viewing the Democratic Party as really prioritizing the needs of people of color in urban communities and immigrants — but not really understanding or caring about rural people who are struggling, as well.

This last bit from Mettler is, to my mind, so important.  What Mettler doesn't say is how academics contribute to this problem of saying that so-called rural resentment is all due to racial animus.  See some nuanced and thoughtful pushback to that notion--or at least the notion it is all so simple--in this academic article.   

I'll no doubt have more to say about Mettler and Brown's book in future posts, after I've read it.   For now, I'll just say that three of my recent publications aim to take a more optimistic tack regarding rural voters.  They encourage progressives to play to rural residents' rural identity--to show them that they and their needs are seen.   Read more here, here, and here.  I'm somewhat less optimistic here, while still taking seriously the need for politicians--including those on the left--to respond to rural needs.  

No Kings protests in rural California

October 11, 2025, Point Arena, California

I was struck this weekend by reports of "No Kings" rallies in northern California, including the region referred to as the "North Bay," including Sonoma, Napa and Mendocino County.  What's striking, of course, is that rural areas are reputedly conservative.  That said, coastal California is certainly more progressive than the interior parts of the state.  (This point is well illustrated by recent debates of redistricting in California and Proposition 50, which will link these parts of the North Bay with uber-rich and uber-progressive Marin County, just north of San Francisco).  The photos in this post I took on October 11 in the town of Point Arena, in coastal Mendocino County.  

Here are the places listed in The Press-Democrat (based in Sonoma County but also covering Napa and Mendocino counties) where "No Kings" rallies were held on Saturday:  

∘ Protest General Dynamics. No Bombs, No Borders

Time: 10 a.m.-noon

Location: Healdsburg Farmers Market at the intersection of West North and Vine streets (first and third Saturday of the month) or the traffic circle at the intersection of Mill Street and Healdsburg Avenue (all other Saturdays)

∘ Gualala Weekly Protest

Organized by: Let Freedom Ring ~ Pro Democracy March

Time: 10 a.m.-noon

Location: Gualala Hotel, 39301 South Highway 1, Gualala

∘ Point Arena Weekly Protest

Organized by: We Are Democracy

Time: 10 a.m.-noon

Location: Downtown Point Arena

∘ Fort Bragg Weekly Protest

Time: 11 a.m.-noon

Location: In front of Guest House Museum, 343 North Main St., Fort Bragg

∘ Healdsburg Weekly Protest

Time: 11 a.m.-noon

Location: Healdsburg Plaza, Healdsburg

Point Arena, California (Oct. 11, 2025)
These signs were plentiful in businesses of coastal Mendocino County merchants.

∘ Petaluma Weekly Protest

Time: 11 a.m.-noon

Location: East Washington Street and Petaluma Boulevard, Petaluma

∘ Trump Regime Takedown Banner Drop

Time: 11 a.m.-1 p.m.

Point Arena, California (Oct. 11, 2025)

Lots of rural (and Southern) stereotypes in today's NYT opinion

Today's NY Times opinion podcast featured three southerners in conversation under the headline, "There is No Trump Without the South."  Here are some excerpts that play to stereotypes of the South--and its conflation with rurality. (That conflation is not entirely inaccurate in that the South is the most rural region of the nation).  Rural-urban tension is also touched on, as a sort of parallel to the tension between the South (and what it represents) and the rest of the nation.  

Jamelle Bouie:  

One observation everyone in this conversation has made and other people have made is the way that there has emerged an almost generic national rural culture.

It’s a certain kind of country music. It’s a certain kind of pickup truck. You see it if you go to rural New Hampshire, if you go to rural Montana, if you go to rural Illinois. It’s very much rooted in a franchised version of a white Southern rurality.

And I bring that up to say that it’s both the case that the country will shunt its difficult conversations, as Tressie said, about race to the South and make it a Southern problem. But it’s always been the case that the rest of the country has been fascinated by the South in really important ways.

* * * 

Tressie McMillan Cottom: 

Every time a Southern politician goes out and they congratulate themselves about building the new car factory or the new battery maker in some rural part of their Southern state or municipality, what they have generally done is they have made a deal with either a national or a transnational conglomerate that says: You do not have to worry about unionizing.

* * * 

And what we are seeing here is not just a transplant of people but of ideas that don’t necessarily create that kind of mobility for Southern workers across the South, which then leads to a war, a battle for the soul of rural America that you can feel very tangibly in the South.

David French: 

I come from a town — when I was growing up there, it was about 8,000 people. We had three stoplights in a rural town in Kentucky. That’s where I spent my elementary and high school years, and it’s unrecognizable now because a Toyota manufacturing plant came there and completely transformed the city.

But these are good, high-paying jobs. They are transformative jobs in these parts of the South, but it is absolutely true that they also pull and draw jobs from other parts of America. And it’s one of the reasons I think so many people have been moving to the South.

Bouie:

But I also want to say that part of the allure of the South as a cultural object — and this is getting back to what Tressie had said earlier about cost of living — is not simply that things might be cheaper but that you have an opportunity to use your wealth, for lack of a better term, to dominate other people.

You can have a big compound in the middle of Texas and drive a gigantic vehicle and use all the resources you’d like and boss people around.

McMillan Cottom: 

It’s the “Yellowstone”-ification of the country, Jamelle.

Bouie: 

Yes. And that aspect of it — there’s no policy you can do to compete with that, I guess. Because what a place like California is offering, the trade-off is it’s going to be more expensive to live there. Unless you are in the highest echelon of income earners, you’re not going to be able to hire someone to look after your house for dirt cheap, right? You won’t be able to exploit someone so easily.

But you are going to live in this multicultural, cosmopolitan place where people are going to exist, at least culturally, on some plane of equality. And if you like that kind of life and experience, that’s what you’re in L.A. for, that’s what you’re in New York for, that’s what you’re in Chicago for and all the places that are their own places but offer a smaller or more manageable versions of that thing.

* * * 

McMillan Cottom: 

Now, I think at the state level — again, especially in a place like North Carolina — we tend to prefer a more socially conservative performance of Southern politics. But on the ground, especially when you’re talking about local elections, it is that the Democratic Party wants to run a far more conservative candidate than can excite the base across the rural parts of the South.

Bouie: 

I think that it would be a good idea for the Democratic Party to make serious investments in Mississippi, a state where Democratic candidates with no investment routinely hit the mid-40s in statewide elections. That’s a clear sign.

It’s going to be really hard to close that gap because of racial polarization in the state. But the gap can be closed, and making Mississippi competitive would be a huge blow to Republicans if you’re a Democrat. It changes the game.

More on gerrymandering and its impact on far nothern California

Several stories have been published about California's Proposition 50, which would permit re-districting immediately, between the decennial censuses.  It's a topic I first blogged about here, in late August.   

The first is Jeanne Kuang's deeply reported story for CalMatters, from mid-September.  

The headline is a telling, "These rural Californians want to secede. Newsom’s maps would pair them with Bay Area liberals."  Here's the lede: 

Over several rivers and through even more woods, flags advocating secession from California flutter above hills dotted with cattle, which outnumber people at least sixfold.

This ranching region with a libertarian streak might have more in common with Texas than the San Francisco Bay Area.

But it’s not Texas. Five hours northeast of Sacramento on an easy day, Modoc County and its roughly 8,500 residents are still — begrudgingly — in California.

And California is dominated by Democrats, who are embroiled in a tit-for-tat redistricting war with the Lone Star State that will likely force conservative Modoc County residents to share a representative in Congress with parts of the Bay Area.

Modoc County and two neighboring red counties would be shifted into a redrawn district that stretches 200 miles west to the Pacific Coast and then south, through redwoods and weed farms, to include some of the state’s wealthiest communities, current Democratic Rep. Jared Huffman’s home in San Rafael and the northern end of the Golden Gate Bridge, all in uber-liberal Marin County.

“It’s like a smack in the face,” said local rancher Amie Martinez. “How could you put Marin County with Modoc County? It’s just a different perspective.”

* * * 

Though Modoc County supervisors have declared their opposition to Prop. 50, there’s little else locals can do. Registered Republicans are outnumbered by Democrats statewide nearly two-to-one. Rural residents represent an even smaller share of the state’s electorate.

“It’ll be very hard to fight back,” said Tim Babcock, owner of a general store in Lassen County, a similar and neighboring community that’s proposed to be drawn into a different liberal-leaning congressional district. “Unless we split the state. And that’s never going to happen.”

Here are some key quotes highlighting the rural implications of the proposed redistricting.    

County Supervisor Geri Byrne said she knew it was a longshot — but thought, “when’s the last time The New York Times called someone in Modoc County?”

Byrne, who is also chair of the Rural County Representatives of California and of the upcoming National Sheepdog Finals, said the secession resolution was about sending a message.

“It wasn’t conservative-liberal,” [Byrne] said. “It was the urban-rural divide, and that’s what this whole Prop. 50 is about.”  

Even a Democratic resident running a produce pickup center in Alturas observed that her neighbors are “not that Trumpy.” Instead, there’s a pervasive general distrust of politics on any side of the aisle.

* * *

Flourishing wolves are a problem

At the moment, all anyone can talk about is the wolves.

The apex predator returned to California more than a decade ago, a celebrated conservation success story after they were hunted to near-extinction in the western U.S. Now they’re flourishing in the North State — and feeding on cattle, throwing ranching communities on edge. Federally, they’re still listed as an endangered species under the landmark conservation law signed by President Richard Nixon.
Under California rules, ranchers can only use nonlethal methods to deter the wolves, like electrifying fencing or hiring ranch hands to guard their herds at night.

* * * 

Few Republicans in the state and nation understand “public lands districts,” said Modoc County Supervisor Shane Starr, a Republican who used to work in LaMalfa’s office. “Doug’s the closest thing we’ve got.”

“This whole thing with DEI and ‘woke culture’ and stuff,” he said, referring to the diversity and inclusion efforts under attack from the right, “it’s like, yeah, we had a kid who goes to the high school who dyed his hair a certain color. Cool, we don’t care. All of these things going on at the national stage are not based in our reality whatsoever.”

At a cattlemen’s dinner in Alturas one recent evening, Martinez said she once ran into LaMalfa at a local barbecue fundraiser for firefighters and approached him about a proposal to designate parts of northwestern Nevada as protected federal wilderness. Her 700-person town of Cedarville in east Modoc County is 10 minutes from the state line.

Martinez worried about rules that prohibit driving motorized vehicles in wilderness, which she said would discourage the hunters who pass through during deer season and book lodging in town. Even though the proposal was in Nevada, LaMalfa sent staff, including Starr, to meetings to raise objections on behalf of the small town, she said.

“I know we won’t get that kind of representation from Marin County,” she said.

Reached by phone, Huffman defended his qualifications to represent the region.

Adding Siskiyou, Shasta and Modoc counties would mean many more hours of travel to meet constituents, but Huffman pointed out his district is already huge, covering 350 miles of the North Coast. And it includes many conservative-leaning, forested areas in Trinity and Del Norte counties. A former attorney for the environmental group Natural Resources Defense Council, he’s the top Democrat on the House Natural Resources Committee, where [first district congresswoman Doug] LaMalfa also sits.

Then there is this more recent story by Bloomberg's Maxwell Adler, which features the following lede: 

California’s Marin and Modoc counties lie more than 200 miles apart — and several worlds away.

Modoc, tucked into the state’s remote northeast corner, lacks a single traffic light. Many of its 8,500 residents once lost internet service after squirrels chewed through a fiber-optic cable. Ranchers fear wolf attacks on cattle.

Tech-industry wealth, meanwhile, has transformed Marin from a bohemian refuge outside San Francisco into one of California’s richest communities. Traffic regularly jams the freeway into the city, and residents fight over efforts to build more homes.

On the same day, the New York Times published this story about Kevin Kiley, a Republican congressman from greater Sacramento who represents a very rural district stretching down the eastern Sierra.  He would almost certainly lose his seat if redistricting occurs.   

Here's coverage from the California Farm Bureau, "In Rural Districts, Backlash Mounts Against Prop. 50." 

In contrast to these rural-focused stories, Politico published this September 7, 2025 piece  covering the California GOP meeting.  It does not even acknowledge the concern regarding lack of representation of rural concerns.  It includes no use of the word "rural." 

On the USDA Economic Research Service website right now: a reference to the "Radical Left Democrats"

 
A banner at the top of the USDA Economic Research Service website reads:  

Due to the Radical Left Democrat shutdown, this government website will not be updated during the funding lapse. 

President Trump has made it clear he wants to keep government open and support those who feed, fuel and clothe the American people. 

Frank Morris reported yesterday for NPR on how the government shutdown is impacting farmers. 

Rural lack of anonymity in the wake of Tennessee explosion

An explosion yesterday at an ammunition plant in McEwan, Tennessee, population 1643,  left several dead and many missing.  In the Washington Post's coverage of the disaster, I was struck by these comments from the Humphreys County Sheriff in that they reflected rural lack of anonymity.  

Nearly 12 hours after the explosion, law enforcement officers were still trying to contact victims’ families, Davis said, adding that officials planned to work through the night to keep looking for possible survivors, interviewing witnesses and family members, and trying to find out what happened.

“It’s hell on us,” he said. “It’s hell on everybody.”

The close-knit nature of the community compounded the pain. Davis said that he’s “very close” with at least three families involved in the explosion and that the sheriff of the neighboring county could say much the same. That closeness drove Davis to keep looking for survivors, caring for the injured and consoling the bereaved, he said.

“When you have small counties like this, we know each other, we communicate with each other, we love each other,” Davis said. “And that’s what — honestly, it’s what keeps my motivation alive.”

“We’re working for our people,” he added.

This is from the New York Times coverage of the explosion: 

The explosion has shaken the small, tight-knit communities in Hickman and Humphreys Counties, which have a combined population of about 44,000.

One of the communities is known as Bucksnort, where there are winding dirt roads, ample hunting ground and just a handful of businesses. Steven Anderson, who runs a trout farm there, said there were only three points of interest in town — the trout farm, the munitions plant and a gas station with a convenience store where he said workers from the plant often eat lunch.

Postscript:  On October 13, the New York Times ran this story, "A Tennessee Sheriff Becomes the Face of Grief after Plant Explosion."   

Maine Law Review Call for Papers. Rural Perspectives in Law: Challenges and Opportunities

The Maine Law Review is seeking article proposals for our topical issue: Rural Perspectives in Law: Challenges and Opportunities.  This issue will be published in spring 2026 as Volume 78.2 of our legal journal.

Abstracts of 300-500 words will be reviewed on a rolling basis and should be submitted no later than October 1, 2025, at 5:00 PM.  All submission should be sent to mlreditor@maine.edu.

Rural communities across the United States face unique legal challenges that often differ from those in urban and suburban settings.  Issues such as access to justice, scarcity of adequate legal counsel, limitations due to aging infrastructure, and the impact of shifting industries and demographics shape the practice of law in rural America.  Maine is the second most rural state in the country with 62% of its population living in rural areas. However, most of the legal providers are located in the more urban, southern portion of the state.  Rural communities outside of Maine face similar challenges.  

This volume is meant to speak about the challenges and potential opportunities rural communities across the nation face, and contribute to a broader conversation about how the law and policy can better serve rural America. 

Articles published in this upcoming volume of the Maine Law Review have the opportunity to contribute to an evolving area of law and to provide practical guidance and commentary on a pressing issue many rural communities across the nation are facing. Potential article topics could include but are not limited to: 

• Access to legal services in remote communities.
• The rise of virtual court hearings and tele-lawyering, and their impact on legal services.
• Infrastructure challenges in rural communities including broadband, utilities, etc., and legal solutions to them/the role of attorneys in rural economic development. 
• Unique issues to rural communities in areas of interest like family law, criminal law, property law, or impacts to rural economies or heritage industries.
• Property issues including zoning ordinances, land use regulation (farming, fishing, forestry, cannabis, etc.), or the impact of pollution/climate change on economic revitalization.
• The impact of federal funding priorities and the potential disproportionate impact on health or public services. 
• Recruitment, retention, burnout, and retirement of attorneys in rural communities.  

 The editors encourage creative and diverse viewpoints, and encourage interested authors to submit proposals on legal topics of interest that impact rural communities. 

Literary Ruralism (Part LI): Attention to "rural" in Dan Wang's Breakneck, on China's rise

Breakneck:  China's Quest to Engineer the Future by technology analyst Dan Wang was published last month by W.W. Norton.  The promotional blurb touts the book, in part, thusly:  

Wang blends political, economic, and philosophical analysis with reportage to reveal a provocative new framework for understanding China—one that helps us see America more clearly, too. While China is an engineering state, relentlessly pursuing megaprojects, the United States has stalled. America has transformed into a lawyerly society, reflexively blocking everything, good and bad.

I came to the book after listening to Ross Douthat's interview with Wang on the "Interesting Times" podcast.  While Wang's book primarily contrasts the differing approaches to development and infrastructure of the United States and China, it often raises the matter of rural-urban difference and how those differences play out in the two countries.  I was intrigued, for example, by Douthat's comparison of Guizhou, a backwater Chinese province that Wang uses to illustrate an underdeveloped place, to West Virginia.  The transcript from the podcast features this from Wang: 

Guizhou... is a land where a local said, “Not three feet of land is flat, not three days go by without rain and not a family has three silver coins.”  China’s fourth-poorest province, I was surprised to see, had much better levels of infrastructure than one could find in much wealthier places in the United States, like New York State or California.

We saw very tall bridges all around us. We saw a guitar-making hub. We saw a lot of fancy new roads that were a cyclist’s dream. And it was only afterward when I realized how bizarre it was that China’s fourth-poorest province — about the level of G.D.P. per capita of Botswana, much less than Shanghai or Guangdong — was able to build all of these things.

It is a province with 11 airports, 50 of the highest bridges in the world and brand-new, spiffy highways — and that’s because China was just building a lot in its equivalent of a South Dakota or West Virginia.

That's a good introduction to the book excerpts that follow.  I have highlighted the word "rural" in context.  

Modern China has many tools of social control. Within living memory, most Chinese residents worked inside a danwei, or work unit, which governed one’s access to essentials like rice, meat, cooking oil, and a bicycle. Many people still live under the strictures of the hukou, or household registration, an aim of which is to prevent rural folks from establishing themselves in cities by restricting education and health care benefits to their hometown. Controls are far worse for ethnoreligious minorities: Tibetans are totally prohibited from worshipping the Dalai Lama, and perhaps over a million Uighurs have spent time in detention camps that attempt to inculcate Chinese values into their Muslim faith. 

The engineering state can be awfully literal minded. Sometimes, it feels like China’s leadership is made up entirely of hydraulic engineers, who view the economy and society as liquid flows, as if all human activity—from mass production to reproduction—can be directed, restricted, increased, or blocked with the same ease as turning a series of valves. (pp. 5-6)

* * * 

The Guizhou locals we chatted with were prouder of their bridges than anything else. My friends and I cycled across bridges that were set above plunging ravines. State media boasts that Guizhou has become a “museum of bridges,” a few of which are trying to develop into tourism sites: The tenth-highest bridge in Guizhou (which is twenty-third globally) hosts the world’s highest bungee jump. Each time the engineers build a bridge, they inevitably announce that travel times between two towns have been cut from many hours to perhaps a few minutes. That creates real convenience and connection for rural people. Some of these are bridges to nowhere, but after a few years, they become somewhere. 

(I am reminded of what a "bridge to nowhere" connotes in the United States; read some of my analysis of the political implications of the phenomenon here). 

Still, beneath Guizhou’s engineering marvels are counties mired in poverty. At $8,000 per capita, the province has the income of Botswana, 40 percent below China’s national average and less than a third that of rich coastal cities like Beijing and Shanghai. One day, Christian remarked on how few working-age adults we saw in Guizhou: Those who don’t have a job making guitars have mostly migrated to other provinces, leaving small children in the care of grandparents. In 2010, only half of Guizhou’s children attended high school—the lowest rate in the country. News reports often featured stories of children having to rise at the crack of dawn and hike through harrowing mountain paths, some with rope ladders, to be able to attend school. 

In spite of the challenges of deep rural isolation, China’s fourth-poorest province—where household income is one-fifteenth that of New York State—has vastly superior infrastructure: three times the length of New York’s highways, as well as a functional high-speed rail network. And Guizhou isn’t exactly an exceptional Chinese province. Across the country, the engineering state has relentlessly built public works, making Guizhou an extreme case of China’s growth strategy rather than a deviation from it. 

Modern China has been on a building spree. It began in the 1990s, after economic reopening took hold, and then received another boost in 2008, when the central government approved vast public works to respond to the global financial crisis. (pp. 27-28)

* * * 

The Fourteenth Five-Year Plan outlines interstellar research and other state-directed megaprojects. There’s something for the ordinary consumer too, but it’s nowhere near as exciting. To promote consumption, the plan suggests measures like “expanding the coverage of e-commerce in rural areas,” “improving product recalls,” and “improving in-city duty-free shops.” Fine measures, but puny relative to orbiting Mars. The economic planners have obviously poured their hearts into the scientific projects, whereas the consumption measures look like a hasty afterthought. When Chinese officials talk about promoting consumption, it often involves building new malls or replacing old industrial equipment. In other words, it’s still more about investing to build stuff rather than shifting the propensity of households to spend a greater share of their income. 

Under Mao, China practiced a more literal form of Marxism, with full state control of the means of production. Deng Xiaoping pivoted the country away from that failed experiment. As Deng was fond of remarking, the defining feature of socialism was not economic redistribution but rather “concentrating resources to accomplish great tasks.” That flexible definition allowed for greater adaptability, generated higher growth, and sustained the regime into the twenty-first century. Under Deng’s definition, the United States has also achieved plenty of socialism. The Manhattan Project, the Interstate Highway System, and the Apollo Program all concentrated resources to accomplish great tasks. Maybe even Reagan’s Strategic Defense Initiative could have been understood as socialism. When the engineering state works, it can produce beautiful cities like Shanghai. But Shanghai is exceptional: It has been China’s richest and most westernized city for the better part of a century. The engineering state also produces a lot of problems. To see them, we should return one more time to Guizhou. 

Under the gleaming new bridges lurk not only poverty but also a massive debt burden. The underlying hope of Guizhou’s construction is that infrastructure will invite lasting economic activity. Part of that has worked out: Guizhou incomes have risen by nearly 10 percent annually from 2011 to 2022, driven partially by urbanization and by the tourism facilitated by new infrastructure.  (pp. 37-38)

* * *  

But most of Guizhou’s infrastructure spending looks dubious. Its super-high bridges aren’t producing the revenue to recoup anywhere near their super-high costs. Of Guizhou’s eleven airports, five have less than a dozen flights each week—and there are three more airports still under construction. Guizhou has become one of China’s most indebted provinces, and it’s starting to feel real fiscal distress. In an unusual move, Guiyang’s finance bureau issued a public outcry in 2022 that it was at the end of its ability to deal with the debt. Quickly afterward, the government deleted its own admission. 

Guizhou’s debt has kindled Beijing’s wrath. In China, the only people scarier than debt collectors are political inspectors from the central government. The Communist Party has unleashed teams of officers from the Central Commission for Discipline Inspection to descend on Guizhou. They are unbound by even the modest levels of legal niceties afforded in China. Rather than investigating legal crimes, their remit is to find “violations of party discipline,” a nebulous charge that includes not only corruption but also misuse of public funds and political disloyalty to the Communist Party. That makes the commission akin to the Inquisition, enforcing doctrine and discipline on its members. (pp. 38-39) 

The worst-affected people are targeted minority groups, who have to bear Beijing’s social engineering. The state has singled out, for example, Tibetans, who are forced to relocate from high-altitude mountains, where they are able to graze their yaks and horses, to lower-altitude farms in part to monitor them more easily. What are yak herders supposed to do when they move down to apartment blocks? Rural people who know only their farming or pastoralist lives are often at loose ends when the government resettles them into rows upon rows of high-rises. Two researchers at the University of Colorado have documented China’s coercive tactics to compel locals to leave their homes. It is a process it calls “thought work,” ranging from presenting resettlement as a voluntary and happy choice to holding intensive one-on-one meetings with recalcitrant folks who do not want to leave. Officials mix inducements with threats until they wear down the farmers. Thus, the state has been able to achieve “voluntary” resettlement rates of 100 percent. 

Reckless construction has often produced rubbish quality. Builders employed cheap materials to construct even schoolhouses. The 2008 earthquake that tore through Sichuan also shattered thousands of schoolrooms, killing five thousand children (according to official figures).  (pp. 48-49)

* * * 

Though rich students in Shanghai score splendidly on international exams, education in China’s rural areas is still often abysmal. The Covid pandemic revealed that the country’s health care system is weak, with shortages of doctors and nurses and six times fewer intensive care unit beds per capita than in the United States. An official like Li Zaiyong might be more interested in building a gleaming hospital filled with sophisticated equipment. Their attention drifts, however, when it comes to installing the trained technicians capable of operating the facility, since the Communist Party is better at rewarding new construction than health outcomes. 

The engineering state is focused mostly on monumentalism. Though there are many public toilets, provision of toilet paper is only a sometimes thing. Nowhere in China is it advisable to drink tap water. Not even Shanghai. The engineering state has engaged in wild spasms of building over the past four decades. That has achieved considerable wonders and a fair degree of harm. The future would be better if China could learn to build less, while the United States learns to build more.

I’ve come to realize that there are many ways that China and the United States are inversions of each other.  (pp. 49-50) 

* * * 

China’s overbuilding has produced deep social, financial, and environmental costs. The United States has no need to emulate it uncritically. But the Chinese experience does offer political lessons for America. China has shown that financial constraints are less binding than they are cracked up to be. As John Maynard Keynes said, “Anything we can actually do we can afford.” For an infrastructure-starved place like the United States, construction can generate long-run gains from higher economic activity that eventually surpass the immediate construction costs. And the experience of building big in underserved places is a means of redistribution that makes locals happy while satisfying fiscal conservatives who are normally skeptical of welfare payments. 

Rather than worry about bond vigilantes, the engineering state has focused on delivering material improvements for the people. Rural folks in Guizhou have seen their material conditions of life improve immeasurably over the past few decades. The mixture of permitting free enterprise while building big infrastructure is part of the reason that the Communist Party has held on to consent of the governed.  (p. 54) 

I'll write a separate post later about the rural-urban divide in relation to China's one-child policy.  

Will proposed California redistricting undermine rural interests?

The answer most folks from rural California would give to this question is "of course."  But I want to look a bit deeper than that in this post and consider how it is that rural interests will lose ground if gerrymandering runs amok in California, depriving rural interests of the representation they currently enjoy in the U.S. Congress.  I'll begin with some of the coverage of the proposed re-districting, coverage that does justice to the rural concern. 

The most comprehensive coverage I've seen was in the Sacramento Bee, where Nicole Nixon and Lia Russell reported from Redding.  The August 22 headline was "What’s in a district? Rural Californians react to Democratic gerrymandering play."  Here's an excerpt that provides the big picture on what's being proposed: 

To help Democrats win, the proposed congressional map would carve up rural Northern California areas — which are heavily represented by Republicans — and put them in bluer urban and suburban districts.

State Sen. Megan Dahle, R-Bieber, called the proposed map “a straightforward attempt to disenfranchise rural voters.”

Dahle represents the North State, with many of the same constituents as LaMalfa. The proposed map creates more compact congressional districts by breaking up large rural ones to include voters in more urban areas. In particular, it would carve up two sweeping districts in Northern California into four new ones, each with an arm stretching to the coast or into Sacramento-area cities, to include higher concentrations of Democratic voters.

“Nobody who claims to represent rural California can support this,” Dahle said.

Newsom’s office declined to comment on the consequences for rural Californians and directed questions to members of the Legislature.

Nixon and Russell also quote Darek Velez, who recently moved to Redding, the county seat of Shasta County and long the largest city in the "north state."  Velez calls himself a centrist. 

Redding is its own area. It’s been fought for. People have a lot of pride in calling it the North State up here.

* * * 

Redding, which often serves as a stopping point for visitors on their way to Mount Shasta and Lassen National Park, would be included in the new second district — a cockeyed gerrymander that would bring conservative corners of the North State together with northern parts of Marin and Sonoma counties, one of the wealthiest and most liberal areas in the state.

The journalists call Velez a "rural resident" (a stretch given the 95,000 population of Redding), and quote him as saying the new maps would take away "rural voters’ 'freedom of speech.'"  Here's a further quote from Velez:  

To change our minds and call (the North State) the mid-state just doesn’t really reflect what everybody wants.  And I think people come up to Redding too from all over the state that like the solitude and what it represents up here. Going to Marin County, like being part of San Francisco, doesn’t make sense.

Nixon and Russell then quote Doug LaMalfa, who has represented the state's first congressional district since 2013 and whose seat would become more more competitive:

So now, as a Bay Area representative, are you going to care that much that the wolves are devastating the wildlife and the livestock in Modoc and Sierra and Lassen County?  Are they going to care that much? Or are they going to listen to Marin constituents and say, ‘Well, wolves are great. They’re wonderful.’

James Gallagher, Republican Assemblyman from Yuba City and chair of the Republican caucus, has also focused on the consequences of the re-districting for rural Californians.  Indeed, Gallagher has called for a "two-state solution" that would divide California.