RFK Jr. promotes AI nurses as a solution to the rural health care crisis

Robert F. Kennedy Jr., an environmental lawyer, has spent his career spreading health misinformation and conspiracy theories. Some of his most popular (often baseless and debunked) claims include that vaccines cause autism; Wi-Fi causes cancer and "leaky brain"; school shootings are attributable to antidepressants; chemicals in water can lead to children becoming transgender; and drinking raw milk is advisable.

His views on these issues and others have fostered great concern among the healthcare community, especially in the time since his nomination to lead the Department of Health and Human Services. In this role, Kennedy would oversee programs such as Medicare, Medicaid and the Affordable Care Act, public health response to epidemics, and approval of pharmaceutical drugs, vaccines, and medical supplies.

Kennedy promises to bring an overdue focus to American health problems through his “Make America Healthy Again” agenda, which targets frustrations with the health-care system, reliance on processed food, increase in chronic disease, and decline in life expectancy.

Kennedy has recently weighed in on the rural health care crisis. When asked during his January 29, 2025 confirmation hearing how he would address health care workforce shortages in rural communities and frontier areas, Kennedy replied that rural hospitals was one of the most unifying topics among lawmakers, and that President Trump had asked him to address the crisis with AI and telemedicine.

Kennedy told the Senate Committee on Finance that the Cleveland Clinic:

[H]as developed an AI nurse that you cannot distinguish from a human being that has diagnosed as good as any doctor. And we can provide concierge care [to] every American in this country, even through the remote parts of Wyoming, Montana, Alaska, etc.

It is true that rural hospitals and clinics are in dire need of government support. (Read more about the rural health care crisis here and here.)

As of 2023, one third of all rural hospitals in the country were at risk of closing because of financial constraints. Further, public health is expected to lose about 57% of its workforce by 2025, with most of the decline attributed to local services such as rural county offices, clinics, agencies, and services. This situation is worsened by a “rural mortality penalty” among rural residents, as consistently revealed by research.

During his first confirmation hearing, Kennedy attempted to address these concerns and emphasized that rural hospitals not only provide important health care for residents, but they also represent important economic opportunities.

However, Kennedy failed to address the most important action the federal government could take to stabilize rural hospitals: expand Medicaid. (Read more about the need for the expansion of Medicaid here.) 

In an MSNBC article, author Paul Waldman explained:

Most of the health care problems rural people face — from closing hospitals to a lack of clinics to a shortage of doctors and nurses — happen precisely because of the limitations of the free market. It’s just not as profitable to sell health care in places with small, often poorer populations spread out over large areas. These problems can only be solved by government intervention and assistance, whether it’s by paying for people’s coverage so hospitals can stay afloat or incentivizing doctors to move to rural areas.

Unfortunately, rural Americans continue to support and elect Republicans, despite their repeated attempts to cut vital programing and confirm unqualified candidates such as Kennedy to run important agencies. If confirmed, it will certainly be interesting to see whether Kennedy implements AI and telemedicine within rural health care systems, and whether the technological advance improves rural health outcomes.

Diversity, equity, and inclusion is not just for urbanites: how Trump’s war on DEI will harm rural communities

Since his inauguration, President Trump has made it no secret that he intends to go after programs supporting diversity, equity, and inclusion ("DEI"). In the span of only a few weeks, Trump has repealed a handful of executive orders promoting DEI in the workplace. Notable among these is Executive Order 11246, signed by President Lyndon Johnson in 1965, which required federal contractors to "take affirmative action" to ensure that their employees were treated without regard to "race, creed, color, or national origin." 

To further his anti-DEI mission, President Trump has issued a slew of his own Executive Orders, including one on January 21, 2025, entitled Ending Illegal Discrimination and Restoring Merit-Based Opportunity. In this Order, President Trump proclaims that DEI undermines the "traditional American values of hard work, excellence, and individual achievement" and exchanges these values for "an unlawful, corrosive, and pernicious identity-based spoils system."

Perhaps no group in the United States is more familiar with these "traditional American values of hard work" than the American working class, which largely overlaps with rural populations. However, rather than President Trump's anti-DEI stance protecting the interests of the working class, his war on DEI is more likely to disproportionately harm poor, rural communities.

In particular, gutting DEI initiatives will inhibit educational access for rural people. For example, Lane Wendell Fischer, a self-described "cisgender white man from Kansas" writing for The Daily Yonder, described how he has personally benefited from DEI programs. As a rural college applicant from a working class background, Fischer had accepted his fate of eternally paying off student loan debt in order to earn a college degree. However, he was encouraged to apply to an Ivy League school, and was accepted into Yale University with a near-full ride scholarship in part due to a DEI initiative designed to recruit rural students.

Fischer emphasizes the importance of rural representation in higher education and beyond. Without rural students in higher education, how will rural interests be represented in companies providing healthcare or insurance to their communities? Who will bring the rural perspective to authoritative bodies, such as Congress? 

Similarly, who will provide legal representation to rural communities? Given that many rural areas have become legal deserts, a lack of DEI initiatives prioritizing rural representation in schools will exacerbate the already existing lawyer shortage.

Further, President Trump's mission to root out DEI will not only impact educational access in rural communities, but will restrict environmental justice initiatives as well. For example, the President has revoked Executive Order 12898, Federal Actions to Address Environmental Justice in Minority and Low-Income Populations, which directed federal agencies to center environmental justice and address "disproportionately high and adverse human health or environmental effects" on minority and low-income populations.

So far, President Trump has already begun eliminating funding and positions related to environmental projects, including those designed to aid small communities. While projects which have already received funding are in the clear, those for which funds were pending will suffer. 

Examples of the communities that may be impacted include places like Danville, Arkansas, where a 122 mile EF-4 tornado rampaged the county in 2008. Because Danville is a poor, rural community, $2.5 million in federal funds was allocated to build a school tornado shelter.

In an interview with CNN, Professor Robert Bullard, a sociologist dubbed "the father of environmental justice," poignantly stated, "it's not DEI (to have) the right to breathe clean air (or) drink clean water." Unfortunately, the politicization of DEI will only serve to exaggerate rural vulnerabilities and disproportionately restrict the rights and resources rural people require to survive and thrive.

Cowboy boots & Carhartt: The revitalization of cowboy couture

I bought my first pair of cowboy boots when I was in the first grade. I wanted to be like Jesse from Toy Story, I told my parents. Fast forward to my freshman year of high school, I found myself buying a new pair from Ariat when we went to visit my grandparents in Houston, Texas. I wore them proudly to country concerts at the Shoreline Amphitheatre and “ironically” to Outside Lands music festival in Golden Gate Park. 

My infatuation with “cowboy couture” took a hiatus until college. During my sophomore year, I came home for break one year wearing a green Carhartt hoodie. My dad, born and raised in Houston, asked me why I was dressed like my cousins who go hunting, fishing, and mudding on the weekends. I told him it’s what everyone was wearing, but I had no idea why. 

To this day, cowboy boots and Carhartt hoodies are back and bigger than ever. From the streets of Copenhagen to Gen Z on TikTok, it is now socially acceptable to wear cowboy boots to a night out with friends or a camo hat to the farmers market. Camo hats have also taken over, most recently seen during Vice President Kamala Harris’s campaign. MSNBC said it best when reporting on Vice President Harris’s choice to make camo hats her main piece of campaign merch: 

While camouflage never truly exits the general fashion milieu, it’s enjoying a real moment. This is especially true for men’s fashion, so-called Carhartt-core, in its embrace of ‘90s-era military trends and a subversion of traditionally masculine pieces that perpetually exist outside of high-end fashion.

How did cowboy boots and so-called “workwear” go from a necessity to a fashion statement? American cowboy boots date back to the late 1800s—right around the end of the civil war. According to Buffalo Jackson Trading Co., cowboy boots were made of “thick leather to protect the cowboy’s ankles from bruising against his wooden stirrups, as well as to keep his legs from rubbing against the stirrup leathers.” In short, cowboy boots were made for practical reasons. 

After the rise of cowboy-themed television shows and movies like Big Valley (my personal favorite) and the influence of John Wayne during the 20th century, cowboy boots and camo print have somehow found their way into mainstream media. Gen Z TikTok influencers like Annie Paventy have described wearing cowboy boots as “effortless and chic.” But why is Gen Z’s obsession with cowboy couture a problem? 

The answer is (somewhat) clear: Cowboy boots were built for cowboys. Cowboy boots were, and are, considered a “survival tool." They were made to keep a person’s feet secure while they are riding a horse. Dixie’s perfectly outlines the purpose of cowboy boots here: 

The boot’s iconic heel helped a cowboy keep his feet in the stirrups; the height of the leather protected sensitive parts of the leg from chafing or other hazards while riding. 

Although some may not have a problem with more people wearing traditionally “working class” brands and articles of clothing, some see this as “class appropriation,” a lesser-defined form of cultural appropriation where the wealthy dress like the working class. It seems like cowboy boots, and other clothing associated with the working class, used to serve a purpose. The “appropriation of working class attire” like Carhartt highlights how certain brands used to signify a “working class, blue collar identity” and now signify a kind of “stylish streetwear.” 

Wearing cowboy boots could also be seen as another example of “rural cosplay.” Most recently, newly-elected Vice President J.D. Vance was called an “Appalachian Pretender” by Newsweek, for playing into Appalachian stereotypes in his memoir, Hillbilly Elegy. 

This “rural cosplay” perpetuates the differences between urbanites and ruralites. By wearing clothing that they see as “rural,” urbanites may pretend that they live more simply than they actually do. For example, Isha Nicole, creative director and vice president of marketing at Boot Barn, stated in a Footwear News article from March of 2024: 

“As technology, overstimulation and skepticism continue to spike, a yearning for simplicity and purpose will continue to permeate through self-expression,” she explained. “Western fashion is symbolic of the iconic American cowboy’s spirit — channeling untamed freedom, tenacity and rebellion.”

A counter to the idea of “class appropriation” may be that wearing workwear is appealing simply because of the quality of the clothing, and more people are becoming aware of this. Personally, my Carhartt hoodie’s quality has remained the same since 2018, except for a couple bleach stains. Still, the growing number of celebrities and urbanites wearing brands like Carhartt has increased the prices of workwear which undoubtedly makes it more difficult for people in rural areas and those who earn lower wages to afford the clothes that they wear every day. 

Gen Z probably doesn’t intend to appropriate workwear, but this still might not mean that it’s okay. Perhaps we should all think a little more before we buy a pair of cowboy boots or a Carhartt jacket. 

How marijuana funds schools in rural Colorado

Colorado in 2012, via state-wide referendum, voted to legalize recreational-use marijuana, becoming (alongside Washington) one the first states to do so. One of the campaign promises of legalization in Colorado was the promise that the excess tax revenue generated by legalization would be used to help fund construction projects in public school districts.

Most of these extra funds are distributed through BEST grants (Building Excellent Schools Today) which are used on these construction projects. While the tax breakdown changed in the initial years following legalization, in 2019 the Colorado House passed House Bill 1055, which demanded that 100% of all funds raised by the excise tax on wholesale retail marijuana was dedicated to BEST grants, to be distributed based on an application program available to all public school districts in the state.

As stated on the Colorado Department of Education website (where a school district will start their application for a grant), “BEST grants are competitive, awarded annually and in most cases must be supplemented with local district matching funds.” In order to be awarded a BEST grant then, it is highly likely that a school district, to be competitive, must be able to help supplement a large chunk of the funding.

An overview of BEST grants awarded from the 2019/2020 to 2024/2025 school years bears this out. For the 2019/20 cycle, money supplied by the districts represented 41.18% of the money used for the projects; for 2020/21 it was 47.11%, in 2021/22 it was 45.36%, in 2022/23 it was 43.85%, in 2023/24 it was 41.42% and in 2024/25 it was 34.86% (a compiled list of excel documents from the Colorado Department of Education website detailing BEST Grants from 2019-2024 that has the raw data referred to throughout this blog post can be found here).

It seems it can be hard for rural districts to put up the money to be competitive for these grants. In every year from 2019 to 2024, districts that would have been awarded grants, but were denied due to lack of supplemental funding, were exclusively rural districts (with two exceptions in 2020-21, when a project in Boulder and a project in Pueblo were unable to raise the funds).

It is worth looking at a specific example of how this system of requiring matching funds can directly impact the rural school districts that need the resources. In the 2024/25 grant cycle, school district North Park R-1 in Jackson County, Colorado requested a $52,713,524.19 BEST grant for replacing the Preschool to 12th grade school in the district that serves 150 students, where about 50% of students come from poverty (according to the school district-not the official census data). The grant requested the state of Colorado to help replace the only school that is in North Park R-1. The building is almost sixty years old and is “challenging to work around [] due to the asbestos that is commonly found in buildings of this age.” North Park R-1 was denied, due to being unable to raise the $19,032,673.00 they needed to raise in supplemental funds. The failure to raise the funds can hardly be shocking, as the median household income in Jackson County (according to the 2020 census) is $41,809 and the yearly revenue of the school district is $4,854,820 (with yearly expenditures of $4,765,740). In order to raise the supplemental money for the BEST grant, there was a $20 million bond placed on the November 2024 ballot. The bond, proposed by the school district, would have involved a small raise in property tax on the residents to pay for the roughly $20 million supplement-the increase would max out to $1.8 million in new taxes raised each year.

Jackson County, who voted for Donald Trump by 55 points, failed to pass the bond measure. The small rural community in Jackson County can hardly be blamed on not wanting to raise property taxes in a community that has many families who live on a small/fixed income, and who are facing shrinking enrollment in their school district.

It is not that the BEST grants alone can be blamed, but in the 2024/25 cycle, all of the denied BEST grants (due to lack of supplemental funding) were projects asking for new schools, or drastic renovations to existing schools, in small rural districts. It helps showcase the broader trend, that these small rural districts are working with outdated buildings and worse resources, and state programs that are meant to help are still leaving them in the dust.

The value of a rural life

What is the worth of a life? Are some lives more valuable than others? Weeks after beginning law school, I received a call that my grandmother had woken up paralyzed on her right side--the cause of her ailment--a baseball-sized tumor growing on her brain. Sadly, my grandmother lived only months before passing away from Stage III brain cancer.

Having been quite close to my grandmother and having lived with her for most of my childhood, the speed and suddenness of her death left me with questions. Did something cause her cancer? How did the cancer come on so quickly? Unfortunately, I learned that my grandmother's cancer was not merely bad luck. Instead, my grandmother's cancer was caused by where she was born and raised.  

Starting in 1945 and ending in 1962, the United States government detonated approximately one hundred above-ground nuclear bombs at a testing site in Nye County, Nevada, a massive but sparsely populated county in the west central part of the state. The government agency overseeing the detonations, the Atomic Energy Commission (The Commission), promised residents in the "fallout zone" that the testing was safe. One resident recalled her school teachers leading their class outside, watching the "orange shroud spread across the sky," "the clouds coming over our town and writing our names in the dust." 

Soon after the detonations began, animal birth rates plummeted, and those born often survived only months before succumbing to illness or congenital disabilities. Responding to the alarm, The Commission investigated these occurrences and their connection to the detonations. In fact, in 1957, the Commission allegedly conducted thousands of tests and reports studying the effects of the nuclear fallout on those living within the nuclear fallout zone. Summarizing their findings, The Commission affirmed, "Simply stated, all such findings have confirmed that Nevada test fallout has not caused illness or injured the health of anyone living near the test site."

However, The Commission knew that their reassurances were lies. Declassified reports show that the scientists at the time had reported the deadly effects of nuclear fallout on humans, but The Commission ignored and suppressed that information. Some "downwinders," those living in nuclear fallout zones, recalled doctors coming into their classrooms when they were children, examining their thyroids, and passing out potassium iodide pills to combat the effects of radiation. For The Commission, sacrificing some lives was reasonable to save costs on testing in more remote areas.

Congress passed legislation in 1990 to provide relief to those affected by their actions of nuclear testing. The Radiation Exposure Compensation Act (RECA) expanded in 2000 to include "downwinders" as qualifying for compensation. To be eligible for compensation as a "downwinder," individuals had to prove 1) they were within one of the specified counties during the time of nuclear testing and 2) they contracted one of three specified cancers in one of sixteen enumerated organs. What amount did the government feel appropriate to compensate victims they had knowingly given cancer? $50,000. 

Additionally, the RECA provided $75,000 in compensation to individuals working on-site at the detonation facility and $100,000 to minors of the uranium used in the bombs. Arguably, those individuals had a better understanding of the potential dangers of their involvement, yet they were compensated more than the downwinders who were intentionally lied to about the dangers? 

Seemingly, the government did not equally value the downwinder's lives. As one downwinder put it, perhaps the government thought the downwinders "were Mormons and cowboys and Indians--who cares?"  Speaking of nuclear testing, other downwinders commented that the government "test[s] where they think there are populations that don't matter." 

This raises the question:  Do we value life differently depending on where that life happens to live? Even if we reject that proposition, we must reconcile that rejection with the numerous instances where rural lives are expendable in pursuing "higher" causes.

My grandmother was an incredible person. Her life, and thousands of others, were sacrificed to reduce operating costs--not in the name of science that could save lives. Are we now a society that condones harming and killing if the cost-benefit analysis weighs towards the benefit? Is a life worth only $50,000?

1956 article recognizes still existing barriers to rural practice and accidentally makes a good point

It should perhaps surprise no one that many of the systemic barriers that plague rural lawyers are long standing. Many rural lawyers charge less for their services (in order to ensure that local residents can actually afford their services). But yet, young rural lawyers still have to contend with student loan payments, and if they decide to start their own firms, the cost of overhead expenses such as rent, wages, cost of legal databases, insurance...etc. And in many rural communities, starting your own firm might be the only way to actually get legal work. Rural America is dominated by small firms, which do not hire very often. 

This reality is not new, of course. And recognizing it isn't new either. In 1956, the News & Observer in Raleigh, North Carolina published a series of articles that looked at the income of lawyers and why it had not kept pace with other professions. The central thesis was that lawyers should charge more to accommodate their overhead expenses, and readers were cautioned against lawyers who cut their fees to get their business. 

A screenshot of the relevant section from the November 20, 1956 article is shown below:

. 

The article ignored that incomes in rural North Carolina are appreciably lower than its urban centers, a reality that was even more true in 1956 than it is today. If a lawyer raises his rates too high, he may find himself without the ability to get clients. 

But by ignoring this point, the author accidentally made a really good point: Rural lawyers have to charge less, all while not having appreciably lower overhead expenses. A smaller percentage of what they charge the client ends up in their pocket and thus ends up back in their communities. Simply telling lawyers to raise their fees is not adequate; more must be done to make practicing in rural communities not only financially appealing but feasible.

This article is a good reminder of how long these issues have persisted. 

When will women in rural Missouri have true abortion access?

On November 5, 2024, as much of the country watched Donald Trump regain the presidency, abortion advocates in Missouri celebrated. Amendment 3, a ballot proposition to repeal Missouri's total abortion ban, had passed. Missouri was one of seven states that enacted amendments to protect abortion rights on November 5. And in a state that Donald Trump won by over 18 points, voters had somehow simultaneously restored the right to abortion by a narrow margin of 52 to 48 percent. For abortion advocates, passing Amendment 3 was a hard-fought but undeniable victory. 

Then, the question became: "What's next?"

For rural Missourians, the answer is complicated. Over the past few decades, Missouri has severely limited abortion access. Hit hardest were women in rural communities. For years, there were only three abortion clinics in Missouri, which has a population of over 6 million. By 2017, a Planned Parenthood in St. Louis was the only place in the entire state you could get a medical abortion. And in 2022, Missouri passed the "Right to Life of the Unborn Child Act," a trigger ban that months later became the first in the nation to go into effect when Dobbs v. Jackson overturned the constitutional right to an abortion. 

This was the landscape framing desperate efforts to restore medical access to abortion in Missouri. But celebrations fell quiet in weeks after the election as anti-abortion advocates began to respond. Elected officials in Missouri pledged to "vigorously defend" abortion bans in the state. On January 16, 2025, U.S. Senator Josh Hawley (R-MO) introduced federal legislation to defund Planned Parenthood. I felt my own stomach churn when my little sister, a veterinary student at the University of Missouri, texted me: "I'm getting anxious. About living [here]." 

One-third of Missourians live in rural areas. But even those in urban counties have felt the effects of the decades-long effort to restrict access to abortion. Columbia, Missouri, where my sister lives, has a population of 130,000. But it's over a two hour drive to St. Louis, where the sole abortion provider in Missouri is located. Rural Ozark County ⁠— which has a 29.6 percent poverty rate, the highest in the state — is a four hour drive from St. Louis. Not to mention travel costs, medical expenses, and scraping together time off work — all challenges exacerbated by rurality.

While Amendment 3 granted abortion access until the point of fetal viability, the St. Louis Planned Parenthood cannot legally resume providing abortions. This is, in part, due to a December ruling by Jackson County Judge Jerri Zhang which upheld licensure requirements for abortion clinics — meaning that though Missourians have a renewed right to abortion, there is no place for them to obtain one. This leaves rural women in Missouri vulnerable, particularly those in the southern half, where the nearest abortion clinic might be several states away. 

However, progress was made: In the same opinion, Judge Zhang struck down other restrictive laws, including a 72-hour waiting period and a requirement that physicians who perform abortions have admitting privileges in all hospitals that provide obstetric or gynaecological care within "30 minutes or a 15-minute drive." Judge Zhang considered rural Missourians in the decision, writing that: 

[A] person who travels three hours to get a medication abortion and then returns home, would not benefit from [these restrictions]. If complications arise after taking the medication, the individual would need to seek emergency care at the nearest hospital emergency room, as with any other medical emergency.

Aside from the judiciary, what else can be done? In a state like Missouri, where only 28.9 percent of statewide legislators are women, many will turn to grassroots organizing. "What's Next?," an organization dedicated to improving abortion access in Missouri, has advocated for Know-Your-Rights Trainings and other local initiatives. In a 2024 study by the Kaiser Family Foundation, over 35 percent of rural women reported they wouldn't know where to go or where to find abortion information. This post by Rooney Debutts details other statewide legislative efforts to improve abortion access. 

One thing is clear: The fight for abortion access in rural Missouri is far from over. 

Selma deserves our attention more than one day a year

 On March 7, 1965, 600 activists began peacefully marching in Alabama from Selma to Montgomery to protest the rampant voter suppression of Black Americans. 

Activists chose Selma as the starting point for their march due to its infamous voter suppression, with the Alabama Governor George Wallace opposing desegregation and the local county sheriff opposing Black voter registration drives. As such, only one percent of voting-age Black citizens were registered to vote, and those who tried to vote often faced violence, like police brutality. 

As marchers crossed the Edmund Pettus Bridge in Selma in 1965, 150 Alabama state troopers descended with little to no warning, violently and maliciously attacking and injuring the peaceful marchers with tear gas and clubs. 

The event became known as Bloody Sunday. The attack sparked national outrage that led to the passage of the Voting Rights Act later that year. The city of Selma, and the Edmund Pettus Bridge in particular, became an enduring symbol for the Civil Rights movement. In the 2020 Democratic primaries, for example, nearly every presidential candidate on the ticket visited Selma to commemorate the anniversary of Bloody Sunday.

As we approach the 60th anniversary of Bloody Sunday this year, politicians will surely flock to the city to walk across the bridge, take photos, and declare the importance of voting rights. However, Selma’s voter suppression and lack of resources, the very reason activists chose it as the location for the march nearly 60 years ago, has not been magically resolved.

Instead, Selma remains a deeply rural area with residents who feel abandoned by their government. Selma is located in the Black Belt region of south central Alabama and has a population of around 17,971 people. About 80 percent of that population is Black.

Ryan Zickgraf describes in his article “Politicians Come to Selma Every Year to Commemorate the Civil Rights Struggle, But Nothing Changes” how the downtown is largely made up of empty and crumbling stores and homes. He talks to Selma native, Owen Peak, who warns:

This is a do-or-die time here – we really need help.

Yet, residents feel they are not receiving help when they need it most. In Chris Arnade’s article “‘Still a city of slaves’- Selma, in the words of those who live there,” Council McReynolds, a lifetime resident of Selma, states that all the factories have closed and that:

Selma has been left behind, and folks are certainly not working together.

In 2020, Selma and the surrounding Dallas County had voter turnout of under 57 percent, among the worst in the state. In Jay Reeves’ article “Despite its civil rights history, Selma, Alabama sees steady voter turnout decline,” Resident Tyrone Clarke explains why, despite the extreme effort and bodily harm endured to pass the Voting Rights Act of 1965, residents remain hesitant to visit the polls:

You have a whole lot of people who look at the conditions and don’t see what good it’s going to do for them. You know, ‘How is this guy or that guy being in office going to affect me in this little, rotten town here?’

The numbers tell a similar somber, distressing tale as Selma’s residents. As discussed in a previous blog post, Selma is Alabama’s poorest town. In 2022, the poverty rate in Selma was 29.5 percent. That same year, the median household income was $31,084, less than half the 2022 national average of $74,580. With a high poverty rate and without any prospect of a job, many people turn to using or dealing drugs.

Yet Selma, like the rest of Alabama, has some of the strictest policies concerning drugs, coupled with the second highest incarceration rate in the country; policies that disproportionately affect Black residents. One man from Selma, recently released from prison, commented:

Once I got my felony, I became the walking dead. I couldn’t do nothing. I couldn’t vote, I couldn’t drive, and I sure as hell couldn’t work, so I sat around doing nothing, until I started selling again.

A terrible cycle exists in Selma in which people cannot find a job, turn to drugs, get arrested, and then receive a felony on their record that disqualifies them from more work and the right to vote for politicians who will make the town better.

The yearly pilgrimage to Selma highlights the irony of celebrating a pivotal moment in civil rights history in a town that fails to reap any concrete benefits of that progress, and feels the lasting impact of centuries of discriminatory policies.

As politicians flock to Selma for their annual visit and photo-ops, they should prioritize Selma the other 364 days of the year. While the Voting Rights Act of 1965 should be celebrated, the work to push forward civil rights is far from over in Selma.

Country roads, I’m coming back home

After almost a decade of losing population, rural America has seen renewed population growth. Between 2010 and 2020, the article “Rural America Lost Population Over the Past Decade for the First Time in History” describes how rural areas lost population compared to previous decades. The decline did not occur only in remote rural areas but also in rural areas adjacent to metropolitan counties. John Cromartie, a geographer from USDA in the Rural Economy Branch, Resource and Rural Economics Division, found a negative rural net migration rate between 2010 to 2016 and a near-zero rate between 2017 and 2020.

However, since 2020, rural net migration rates have increased. The 2023 USDA Economic Research Report, “Rural America at a Glance,” discusses how more than 480 rural counties saw a growth rate of two percent or more. Typically, these counties were near large metropolitan areas such as the southern Appalachians and Ozarks, the northern Great Lakes, and the Rocky Mountains. Population migration to these recreation and retirement destinations is often referred to as “amenity migration.”

One reason for the major shift in migration patterns was fear of exposure to COVID-19. Early in the pandemic, the USDA Economic Research Service reported that the presence of COVID-19 cases was higher in metropolitan areas until October 2021. This likely caused urban residents to seek shelter in rural places. However, soon after, nonmetropolitan areas started to experience a greater prevalence of cumulative COVID-19 cases than metropolitan areas.

Another reason for the big shift in migration patterns was an increase in remote job opportunities. The U.S. Bureau of Labor Statistics indicates that telework increased among all industries between 2019 and 2021. When social distancing policies were removed in 2022, remote work participation fell slightly but was still higher in most industries compared to participation in 2019. “Rural America at a Glance describes how remote jobs have provided the working-age population with more flexibility and locational freedom. In addition to attracting new residents, employment opportunities have encouraged people to stay within these rural areas. In 2022, rural America reached record-low unemployment rates. Federal legislation, notably the Inflation Reduction Act of 2022, provided new jobs for rural Americans in the clean energy industry.

Although rural America has been slowly growing its population, both current and future rural Americans are still facing problems. For example, “Rural America at a Glance” reports that housing insecurity remains a persistent issue for low-income nonmetropolitan renters, particularly among Hispanic and American Indian or Alaska Natives. Also, high poverty rates have been an ongoing problem for particular rural counties. Generally, though, poverty has been on a downward trend over the past fifteen years.

Rural America has seen an increase in population after losing a decade of negative and near-zero rural net migration rate. Despite this growth, there are still issues persisting in these areas. If rural America hopes to accommodate these future populations, there needs to be an emphasis on helping to increase resources and opportunities.

For more articles on rural population loss and its consequences, see Aging and population loss in small-town Pennsylvania and California rural schools facing teacher shortages.

Ameliorating the rural attorney shortage by amending the federal Public Service Loan Forgiveness Program

Rural communities throughout the United States are experiencing an acute legal crisis: they aren’t home to enough lawyers. One report estimates that only “2% of small law practices in the United States are located in rural places, even though less than one-fifth of the nation’s population lives in rural locales.” 

The consequences of this phenomenon are tangible. Studies indicate that rural Americans living in legal deserts are more likely to be afflicted by a myriad of issues such as a lack of access to health care, housing insecurity, and substance abuse. These consequences are further compounded by the fact that attorney deserts exist more commonly in high poverty areas. 

So what is the primary cause of rural legal deserts? 

Some reports have cited “social isolation” and a “lack of racial/cultural diversity” as driving forces behind the problem, while others have speculated that “[t]ransportation and associated costs are a burden to those living in rural areas.” These factors, and a number of others, certainly play a role perpetuating the rural attorney shortage. However, the problem is more aptly explained by one looking at one factor: money. 

Rural legal deserts, to a great extent, can be understood as a function of the price of law school and the concentration of job opportunities in metropolitan markets. A study conducted by the Education Data Initiative found that “[t]he average law school graduate owes $130,000 in student loan debts” and that “71% of law school students graduate in debt.” The cost of attending law school, in turn, incentivizes junior lawyers to pursue employment opportunities that will give them the best chance to pay back their loans in a reasonable amount of time. 

One way of doing so is securing employment with a large firm offering high first year attorney salaries. Another common route is working in the public sector which then allows debt laden graduates to take advantage of loan forgiveness programs. 

These paths lead to careers that differ greatly in a number of respects. However, they share one characteristic highly relevant to the subject of rural legal deserts. That is, the overwhelming number of job opportunities with both large private firms and government agencies are in centralized metropolitan areas. As a result, most lawyers find themselves establishing roots in urban communities, thereby decreasing the likelihood that they will ever pursue a career in a rural America. 

So what can be done to address the issue? 

The California Commission on Access to Justice (the “Commission”) has proffered a number of state level solutions to alleviate the problem. These solutions include having law schools expand the scope of their loan forgiveness programs (which are typically reserved for those going into public interest work) to include graduates going into private practice in an underserved community. 

While this state-by-state, school-by-school solution would help, it would leave gaps. As noted by the American Bar Association, less than half of the states have their own statewide loan repayment assistance programs. Rather, the national breadth of the issue and the existence of federal loan forgiveness legislation, when considered together, seem to suggest that the best approach to the problem is a federal approach. 

Rather than having law schools expand the scope of their loan forgiveness programs, a more cohesive solution would be to amend the federal Public Service Loan Forgiveness (“PSLF”) Program, so that first-year attorneys going to work for a private firm located within a rural legal desert would be eligible for debt relief. 

Currently, only those working for U.S.-based government organizations and certain not-for-profit organizations qualify for the PSLF Program. However, in light of the program's underlying purpose -- "to encourage individuals to enter and continue in full-time public service" -- the argument for expanding the statutes employer eligibility carries significant weight. 

Like attorneys performing government services or working for non-profits, private attorneys working out of rural legal deserts perform an important public service.  As noted by UC Davis Law Professor Lisa Pruitt, rural attorneys work with communities suffering "disproportionately from poverty, poor health outcomes, the opioid epidemic, educational deficits, and environmental degradation, among other challenges." 

The argument for expanding the PSLF Program's employer eligibility requirement is further bolstered by the fact the many, if not most, private rural attorneys are paid at similar, or lower, rates than a number of government attorneys. For instance, a district attorney working in San Jose, CA, has an average salary of $127, 518. In contrast, at least one rural legal practice report has found that "[t]he prevalence of indigent clients [in rural communities] contributes to the financial stress that many rural attorneys experience." So, it would not be far fetched to assume that most private rural attorneys make substantially less than other government positions that qualify for the PSLF Program. 

In sum, there exists little basis for excluding private rural attorneys from the PSLF Program. These attorneys offer invaluable services to an often overlooked, highly vulnerable segment of the American population. While amending the PSLF Program might not solve the issue entirely, it may go a long way in helping. 

Rural areas need wildfire prevention funding, but who provides the funding?

The risk of wildfire is growing across the United States. Political battles continue over wildfire resources, such as whether Cal Fire resources were adequately allocated to fight the catastrophic Los Angeles wildfires. As the risk of wildfire grows, the cost of prevention efforts also grows. The question of who pays for these expensive wildfire prevention efforts has not yet been answered.

Rural communities almost always need additional state or federal funding to facilitate wildfire prevention projects. For example, the state of Colorado and its rural populations are prone to catastrophic wildfire events. At the same time, the Colorado legislature is looking “to cut nearly $1 billion in state spending this session.”

This drastic cut in budgeting is concerning to Colorado representatives who represent rural areas with high wildfire risk. Many legislators, like Rep. Elizabeth Velasco, D-Glenwood Springs, are concerned that “budget shortfall could impact wildfire mitigation efforts that they say are becoming more needed — and expensive.”

Velasco is sponsoring House Bill 1078 to address the concerns of the rural communities she represents. House Bill 1078 would create a “workforce of foresters and firefighters with grants for certifications, training initiatives, and an outreach campaign to promote job opportunities.” These foresters and firefighters are crucial to getting wildfire prevention projects off the ground and the funding would come directly from the state. Currently, there are not enough foresters and firefighters to help manage the millions of forested lands in the United States.

However, the Colorado Legislature may not want to spend an additional $3 million on House Bill 1078. Supporters of House Bill 1078 are concerned as party leaders are only supporting bills that have a $0 price tag. Wildfire prevention projects are expensive, but rural communities, like those that Velasco represents, desperately need state funding, and the people to advance such projects.

Rural communities in Colorado are already facing extreme wildfire risk. With recent trends in the number of wildfires across the United States, it's not a question of if Colorado will experience a catastrophic wildfire, but it's a question of when.

In another state facing the same wildfire issues, federal money is going to citizen-led nonprofit groups to help mitigate wildfire risk. Citizens in the state of Oregon have formed nonprofit groups, like the Lomakatsi Restoration Project. Based in Ashland, Oregon, the Lomakatsi Restoration Project sends crews out into the mountains with chainsaws and other equipment to clear underbrush and ladder fuels. The crews have one goal, to “protect the valley from wildfire.”

The Lomakastsi Restoration Project traces its roots back to Hoedads Inc., which is commonly referred to as simply “the Hoedads.” The Hoedads was a large worker cooperative that began in the 1970s and planted trees following logging operations across the Pacific Northwest. The Hoedad's numbers grew and they were “eventually performing a good portion of tree planting in the country, getting millions in federal contracts with hundreds of workers organized into crews.”

Slowly, the Hoedads began to die out as private companies took over. Private logging companies hired cheap migrant labor and the Hoedads couldn’t compete. By the mid-1990’s the Hoedad project was over.

Although there are no more official Hoedad groups, the Lomakastsi Restoration Project is “carrying the torch.” The Lomakastsi Restoration Project receives federal funding but instead of planting trees, they focus on wildfire prevention by removing brush and other high-hazard fuels.

Federal and state funding allows rural communities to implement wildfire prevention projects. Clearing brush and creating fuel breaks is expensive and needs to be done on millions of acres. Over the next decade, the National Forest Service plans to manage 20 million acres in an effort to reduce the severity of wildfires.

Without funding, rural communities across the nation will continue to live in fear of the next catastrophic wildfire event. The destructive power of wildfires continues to grow with climate change. Hopefully, in the coming months, federal and state governments allocate more funding to wildfire prevention projects before fire season returns.