The importance of pharmacies in rural areas

When discussing access to healthcare in rural communities, the focus often centers on hospitals and physicians’ offices—rarely on pharmacies. Yet pharmacies are critical healthcare access points: they provide not only prescription and over-the-counter medications, but also direct access to highly trained healthcare professionals. Pharmacists counsel patients on medications, diagnoses, and general health concerns while serving as trusted, familiar faces in their communities. They answer questions about immunizations, referrals to medical services, common colds, heart attack symptoms, and even pet medications. Pharmacists have a uniquely valuable position in their community-- they possess specialized medical and pharmacological knowledge while maintaining close personal relationships with their patients. 

At the same time, rural hospitals are increasingly at risk of closure due to systemic challenges such as funding reductions, high operational costs, and insurance provider reimbursement inadequacies. An article from Boston University School of Public Health stated that over 100 rural hospitals have closed in the United States over the past decade. The article also found that currently 700 rural hospitals are at risk of closing with 300 of them being at immediate risk of closing. Rural healthcare systems are already strained, and hospital closures further restrict access to care and shift additional pressure onto remaining providers, including pharmacies, critical access hospitals and small clinics, all of which are already few and far between. 

As hospitals close and medical services shrink, rural pharmacies absorb much of the strain. They face growing patient volumes, inadequate reimbursement from insurers—sometimes resulting in financial losses on certain prescriptions—and increasing pressure to expand services such as compounding and immunizations. An analysis by the Rural Policy Research Institute found that 80% of rural independent pharmacies recieved reimbursement less than the cost of acquiring and dispensing medications. Some states, like New York, provide additional reimbursement rates for state medical programs in rural areas to bolster healthcare assess. Additionally, unlike chain pharmacies, independent pharmacies often have the flexibility to adapt. Many provide delivery services for patients without reliable transportation and expand clinical offerings to fill gaps left by other providers.

Despite funding challenges and cuts, there are still signs of support for rural healthcare infrastructure. On December 30, 2025, the New York State Department of Health announced that New York will receive $212 million in 2026 under the federal Rural Health Transformation Program to improve health care access and delivery in New York communities. Programs like this are essential to sustaining healthcare infrastructure and providers in rural areas.

Access to prescriptions has increasingly shifted to mail-order pharmacy services. While mail delivery can be convenient, particularly for maintenance medications, it presents its own set of challenges. Delays, incorrect dosages, stolen packages, or temperature-sensitive drugs compromised during transit can place patients at serious risk. Additionally, mail-order services do not offer the same in-person consultation and real-time problem-solving that community pharmacists provide. Although mail services play a role in rural healthcare delivery, policy efforts should prioritize sustaining brick-and mortar pharmacies that provide direct support. 

Recent retail pharmacy closures have further intensified the strain. The closure of all Rite Aid stores and numerous CVS locations has increased patient volume at independent pharmacies. With a large proportion of rural patients relying on government-funded insurance programs, reimbursement pressures can make profitability difficult. Independent pharmacists must balance delivering high-quality healthcare with managing the financial realities of running a small business. The dual responsibility of being a pharmacist and a business owner adds stress but many remain committed because of the meaningful and tangible impact they make in their communities.

With healthcare in rural areas experiencing increased strain, policymakers should consider how to strengthen pharmacies’ roles. Should independent pharmacies have the ability to prescribe some prescriptions in rural areas? Should federal and state governments allocate greater support to rural healthcare infrastructure compared to urban ones? Rural pharmacies are pillars of community healthcare—the question is whether policy will evolve to recognize, and adequately support, that reality.

Bridging the dirtroad divide: Progressive politics in rural America

Rural America votes Republican. This adage has been true since the 1990s, when a sharp rural-urban political divide emerged. In fact, it's been a frequent discussion on this blog - read more here, here and here. Donald Trump's victory in 93 percent of rural counties in 2024 clearly illustrates how strong this divide has become. Rural America hasn't always been such a Republican stronghold, however, and some rural progressive thinkers are devising ways to return to more left-leaning roots. 

A sign in Plumas County in 2013. © Lisa Pruitt

How did it get like this?

In the 1930s, rural progressivism was at its peak. The Great Depression and a farm crisis in the 1920s had left rural America feeling completely sidelined. Franklin Delano Roosevelt noticed this unrest and centered his initial campaign around the issues affecting lower and middle-income Americans, rural and urban. He planned a "rural renaissance", focused on electrification in rural America and raising crop prices. This was incredibly popular, and rural voters, who had previously voted Republican, largely backed Democrats for the next 40 years.

Between the 1970s and the 1990s, rural and urban America voted in relative sync. Trevor E. Brown and Suzanne Mettler explored this trend in their 2023 article Sequential Polarization: The Development of the Rural-Urban Political Divide, 1976–2020. Their research shows that until the 1990s, rural Americans were barely more likely to support a Republican candidate than their urban counterparts. Now, the partisan gap between rural and urban voters ranges from a 21-point difference in the Midwest to a 14-point difference in the Northeast. 

What changed? 1992-2004 were marked by political and economic upheaval in the United States as urban areas prospered and rural areas suffered from divestment and shrinking industry. No longer feeling seen by the Democratic Party, rural voters defected to the GOP in droves. The divide persisted through 2008-2020. Brown and Mettler state that it was primarily driven by nationalist sentiment. Anti-Black rhetoric during Barack Obama's campaign and presidency, and lack of higher education, led rural voters to identify themselves in opposition to "urban" ideals. 

These trends have led to the highly partisan United States we have today, a hyper-divided United States, where the majority of rural America is Trump country. It should be noted, however, that rural voters aren't all happy with their representation either. A 2020 poll revealed that 87% of non-metro voters feel like the government does not represent people like them. 

So, what now?

When Democrats lost the popular vote in 2004, there was a major party platform shift. Steve Inskeep notes that during that time, the party focused on shoring up both rural and urban voters and turning red districts purple. Inskeep points out that the trend has reversed over the last decade, with Republicans succeeding in turning purple districts red.

Some progressive thinkers and leaders have noticed this trend and want to turn it back around. They believe that rural Americans can still return to their more progressive roots; they just need to hear the right messaging. 

A "Boycott Carrots" sign in Cuyama, CA, a movement to boycott carrots grown by corporate carrot growers over excessive groundwater use. © Lisa Pruitt.

One program seeking to mend the divide is the Rural Urban Bridge Initiative. Founded by Anthony Flaccavento, a farmer and former candidate from Abingdon, Virginia, their goal is to help America think differently, talk differently, and act differently. They reach out to urban political leaders and ask them to consider how to meet the needs of rural communities. 

Their website primarily focuses on convincing left-leaning leaders of the problems in rural areas and how they can help solve them. Their guide cites political scientists and legacy media to explain why rural voters don't take progressives very seriously. There is little in the way of talking points, but it provides plenty of resources for someone just beginning to consider rural issues.

Similarly, Dirtroad Organizing forms yearly cohorts of rural candidates and staffers. They "provide in-depth, personal, community-oriented, long-term support to ensure vitality, stability, and integrity in rural organizing."They focus on free training and supporting rural progressive candidates and staffers. It was founded by Chloe Maxmin, former Maine State Representative and State Senator, and Canyon Woodward, her campaign advisor.

Over 40 graduates of this program have been on the ballot, and some are making real headway in their elected positions. For example, Sarah Keyeski, a Wisconsin State Senator, has sponsored over a dozen bills in her first year in office. Several bills relate to healthcare access, an issue that deeply affects rural populations.

Whether either of these programs will create meaningful change in 2026 and beyond remains to be seen. It's clear, however, that many liberal and progressive thinkers haven't completely written off rural America as Trump-land. Platforms focused on economic resilience and healthcare access can reach rural voters and help them feel less disenfranchised. Candidates from rural areas can lead their communities in a way that represents their unique needs and backgrounds. Either way, it seems Democrats have turned their attention back to rural areas and look to level the playing field this cycle. 

On town hobbies and country hobbies

  On my way to go shoot trap, sometime in 2024, somewhere in Colorado 

 

I spend a lot of time outdoors and in rural locales for my hobbies. I shoot a great deal of trap, and hike even more. Despite the common belief that fresh mountain air and the cool ocean breeze would be just what the doctor would prescribe, I would not say that these rural hobbies are good for my health. Between the lead exposure, my ever increasing appetite for nicotine that perks up only outdoors, and my increasingly protestant knees and hips, I would say that overall it's actually quite the opposite.

Upper Yosemite Falls, Yosemite, 2024 

Much has been said about the rates of firearm ownership and hunting rates within rural localities on this blog. (Read more here and here respectively). Despite this high rate of participation in certain forms of recreation, rural areas continue to decline in participation in any sort of physical activity (Physical activity defined by another study here). 

Anecdotally, I have spent some time in a hunting blind and did not move more than ten meters in a 48 hour timespan once we were established. If rural hobbies are more commonly sedentary, or at least less physically inactive than urban hobbies, this can partially explain the higher rural rates of certain health disorders related to sedentary lifestyles. It seems, then, that there is a rural/urban health divide in the hobby context.

This hobby health divide grows given the fact that some rural hobbies may even be dangerous to its participants. Lead exposure is a common issue amongst recreational shooters. Any personal injury attorney or orthopedic surgeon can give you horrific war stories on the dangers of ATV and dirtbike riding (An incoming study from the University of California, Davis). Municipal laws that allow for the burning of wood campfires impact particulate concentrations in the air, only one degree upstream of increased rates of asthma and other respiratory illnesses (Read the EPA warning here). All three of these hobbies (still necessities for some), hunting (read more here), ATV/dirtbike riding, wood burning stoves, are correlated to rural areas.

In this, I believe there is tension in either the health benefits of the hobbies available to rural/urban denizens, or the accessibility of health beneficial hobbies to rural residents. Even outdoors biking or jogging requires specific accommodating infrastructure, impossible or at least unsafe in car centric rural areas. I am unsure of any potential solutions to this divide. Any sort of increased regulation on dangerous hobbies likely falls into the already dis-favoured paternalism and the intrusion of urban ideals onto the rural practicality. 

One potential is that of encouraging youth athletic participation. Suburban children participate in sports longer and earlier than rural children. It is somewhat studied that these sports can have positive downstream effects on adulthood healthiness. By increasing the already high rural participation in youth sports, rural populations may be induced to be healthier as they age by the retention of these physical hobbies.

On the way to Lake Hensley, California, 2025

Additionally, you still need wooded areas and pools of water to fish and hunt. What happens where there is no infrastructure at all for any type of recreation?  It is already well documented the higher rates of drug and alcohol use in rural and poorer areas. There is less documentation on specifically the proliferation of drug use given a lack of recreation, but it isn't impossible to imagine a correlation there. Consider the old adage of "Idle hands are the devil's workshop."

I finish off with a personal anecdata point. In my mind’s eye, I am in a rural part of Manitoba. The municipality is landlocked. The entire area is within 20 meters of altitude. The highest point is a landfill lovingly called garbage hill hours away in the city of Winnipeg. In the winter, the average temperature is -19C and the lakes and streams have frozen over. There are no convenient oceans or mountains to escape to. I asked my local friend what there is to do. He shrugs, and we very quickly got drunk.

    Elk on the way to Point Reyes, California, October 2025

Rural access to reproductive health care

Credit: California Health Report

Maternal Health

The United States has the highest rates of maternal death, three-times higher than other high-income countries. Maternal health disparities impact certain populations more severely than others. For example, the maternal death rate for black women is 49.5 deaths per 100,000 live births, compared to the US average of 22.3 deaths per 100 million. 

Rural populations face maternal death disparities too. "Noncore" areas (areas outside metropolitan and micropolitan statistical areas defined by the Census) have a maternal mortality rate of 26.8 deaths per 100,000 live births compared to 19.5 deaths per 100,000 for large central metro areas. This likely to only get worse.

Maternal health access has been declining in recent years. In 2024, the National Rural Health Association shared that 36% of U.S. counties, a majority of which are rural, are defined as maternity care deserts. A maternity care desert is any county without a hospital or birth center offering obstetric services. In 2022, more than half of rural counties (58.8%) had no hospital-based obstetrics unit, up from 51% in 2010.

Katy Backes Kozhimannil, a professor at the University of Minnesota School of Public Health, told The Daily Yonder that closures of obstetric units are due to "not having enough revenue to keep the units open, as well as not having enough births and specialized skills to care for obstetric patients and not having enough trained clinicians to keep the unit operating." 

Closure of rural hospitals exacerbates the maternal health crisis in these rural communities. Since 2005, 110 rural hospitals have closed, with almost 800 currently at risk of closure due to financial distress. A previous blog post discussed the rural "slush fund" included in Trump's "Big Beautiful Bill," which would include a $50 billion program for rural health. But this "slush fund" is overshadowed by the fact that the bill will cut Medicaid funding by almost $1 trillion, a cut that would disproportionately harm rural residents.

Credit: Allie Kelly, Business Insider

A study done by Georgetown University Center for Families and Children showed that 47% of children and 18% of adults in rural and small towns rely on Medicaid (numbers that the study predicts underestimate the true values). Also, nearly half of all births in rural hospitals are covered by Medicaid. While the rural "slush fund" may provide some funding for rural heath care infrastructure, its only one-third of what rural communities expect to lose from the cuts. 

Abortion Access

On another reproductive healthcare front, access to abortion clinics from rural areas is limited. In California, about 40% of counties do not have an abortion clinic, a majority of which are rural counties. In Inyo County, CA, most residents live over 200 miles from the nearest abortion provider. The lack of abortion care is shocking in light of California's support for abortion access. But residing in a state that recognizes the right to abortion does not mean its residents automatically enjoy easy abortion access. Avery Van De Berg previously wrote on this blog about the severely limited abortion access in Missouri, despite their amendment to protect abortion rights.

Rural residents in states that have enacted post-Roe bans on abortion face even greater barriers to seeking care. Many residents now have to travel significantly farther to find abortion providers. Sarah Melotte of The Daily Yonder analyzed abortion care data and found that after Roe was overturned, rural travel to abortion providers increased from 103 miles on average to 159 miles on average. This distance can be significantly farther in some rural areas (data showing 800 miles of travel from parts of rural Texas and 492 miles of travel for the average rural Louisiana resident).

What's the Solution?

Policy-makers have proposed solutions to the reproductive health care crisis that rural residents experience. Similar to solutions posed to prevent legal deserts, a solution for maternity care deserts includes recruiting, training, and retaining physicians who provide maternal care. To improve access to care, Telehealth policies have been proposed to bridge the gap between physicians in rural area and maternal care needs. 

Undoubtedly, many of these solutions come down to investment in rural health care. It is yet to be seen how policies like the "Big Beautiful Bill" will actually affect rural health care needs. 

The extinction of mermaids

Photo Credit: UNxArtPartner Create COP25 Haenyeo 2019

Emerald sequins bathed in refracting light. Lavender velvet crushed beneath loose limbs. Shimmering turquoise dappled with the tacky remnants of a cherry ice pop. These were the qualities that sketched the lines of one of my most treasured childhood possessions: a swimsuit, inspired by the 1989 film, "The Little Mermaid." 

In a plastic pool in late 90s, Castro Valley, California, I would spend hours baking under the gaze of an overzealous sun, grieving the mythos of creatures that existed only in daydreams. However, nearly six thousand miles away, on the Island of Jeju, mermaids were very much a reality. 

Photo Credit: UNxArtPartner Create COP25 Haenyeo 2019

The sea women

Evidence of female free divers, or haenyeos (Korean:해녀), first appears in literature dating to the 17th Century. What began as a solely male-dominated field soon shifted into one of the quintessential representations of semi-matriarchal family structure in Asia. To become a haenyeo, women must join a fishing village cooperative, requiring the agreement of other members, and diving rights are often passed on from elderly haenyeo to their daughters and daughters-in-law. 

Diving barehanded, clad in simple cotton mulsojungi, without oxygen tanks or other technological adornments, these women routinely plunge their bodies into the gelid waters off the southernmost coast of the Korean peninsula. For seven hours a day, 90 days a year, haenyeo dive up to 20 meters below the surface to harvest marine resources, including abalone, other mollusks, octopi, sea urchin, seaweed, turban shells, and other shellfish for their families and the community. The spirit of the haenyeo is communal, "The women seek equitable distribution of their harvest, giving away part of their catch to a diver who has a poor catch. Such favors are always returned by the recipient."

As Dr. Ji-In Kim notes, the lifestyle is not without its dangers:

These divers are [also] exposed to decompression sickness because they perform breath-hold dives, and these dives can cause neurological problems, such as muscle weakness and dysthesia, as well as other symptoms, such as vertigo, dizziness, and nausea. In addition, increases in intraocular pressure while diving damage the optic nerves and lead to headaches. Among this group, 83.5% take analgesics and antihistamines during work to prevent the headaches and earaches that occur due to diving, and they often take more than the recommended doses; thus, drug overdose is a serious problem. 

Photo Credit: Blog Duam 

Translating the currents

The adversities, however, have paired with marvels. According to a new study in Cell Reports, generations of diving has literally altered the genetics of divers and their children, passing down a series of psychological adaptations allowing them to dive more safely. Dr. Melissa Lardo and her team observed that:

Haenyeo's heart rates drop[ped] about 50 percent more during simulated dives compared with other groups, which helps them hold their breath longer by limiting oxygen that the body needs and reducing the work the heart needs and reducing the work the heart needs to do...This blood pressure genetic variant can protect the haenyeo as they dive while pregnant-typically, pregnant haenyeo will dive up until the day they give birth, says Ilardo. Researchers suggest this lower blood pressure genetic variant could protect against complications like preeclampsia, a health risk for pregnant women that can be exacerbated by diving. 

Centuries of diving has not only changed the anatomy of their bodies; it has embedded in them, what Dr. Samantha Chisolm Hatfield calls Traditional Ecological Knowledge (TEK). 

TEK "specifically relates to the environment in a given traditional homeland of Indigenous groups and/or Usual and Accustomed areas. This may include but is not limited to: botany knowledge, medicinal application (collection and/or administration), hunting, fishing, gathering, processing of materials(s), caretaking such as burning, coppicing, thinning, astronomy, phenology, time, ecological markers, species markers, weather, and climate knowledge."

In a paper published in the Journal of Marine Island Cultures, Hatfield and Dr. Sung-Hee Kong interviewed haenyeo and concluded that they have highly developed environmental acuity, a unique ability to read environments and document information on environmental changes. This is particularly vital as the collection of resources has steadily declined, and sustainability efforts are necessary to mitigate the ravages of climate change. 

Photo Credit: Bernard Gagnon

The ebbing tide 

After thousands of years, the mermaids of Jeju face extinction. "The practice is dying out. Young women are no longer continuing this matrilineal tradition; the current group of haenyeo divers, with an average age of around 70 years years may represent the last generation." The recalibrated values of a modern Korea are looking increasingly incompatible, threatening to erase the women of Jeju and their stewardship of the peninsula's marine ecology. 

Photo Credit: Peter Chanovec

A coruscation of hope

However, as in all fairy tales, the hope of happy ending remains. In 2016, the haenyeo were included on the UNESCO List of Intangible Cultural Heritage and just this month, haenyeo was added to the Oxford English Dictionary, which many hope will raise awareness for this vanishing way of life. Furthermore, although the population continues to dwindle, younger generations are beginning to answer the haenyeo's siren song. Together, these factors may protect the last of the mermaids. 

California's bid for carbon capture continues, local communities remain divided

A recent proposal to inject and store millions of tons of carbon dioxide beneath wetlands in Solano County, California marks the latest development in carbon capture and storage (CCS) in the Golden State. Integrating large-scale CCS projects with a clean energy grid is part of California's strategy for reaching net-zero emissions by 2045. 

The state is accelerating CCS deployment through legislative efforts (SB 905, 2022; SB 614, 2025), executive actions (E.O. B-55-18, 2018), and policy declarations (AB 1279, 2022). Detractors say (and research supports) that the capacity for CCS deployment is under-proved; CCS perpetuates reliance on fossil fuels, and the focus on mitigation pulls money and attention away from more beneficial climate innovations. 

The Montezuma Wetlands are a series of tidal marshes in the San Francisco Bay estuary. Until recently, the area "was treated as expendable." Proximity to the Bay Area, lower population numbers, and agricultural land use meant that "[b]y the end of the 20th century, much of the area functioned less as a marsh and more as a repository for industrial waste," Miranda de Moraes wrote in Grist a few days ago. Over the last two decades, ongoing, large-scale restoration efforts have seen the wetlands make a remarkable recovery. In 2020, tidal flows returned and the marsh resumed providing habitat, flood protection, and other ecosystem services to the region. 

Montezuma Hills along the Sacramento River
Image source: public-domain-image.com (2013)

Given this history, the newly-proposed NorCal Carbon Sequestration Hub raises the sore issue of Solano County's role as a dumping ground for the Bay Area's toxic waste. The new CCS storage project seeks to "inject CO2, sourced from refineries, hydrogen plants, and power plants" into the saline aquifers a mile or so below the wetlands. The storage site would be located around the small town of Collinsville. According to Grist, project architects hope to be depositing up to 8 million tons of carbon dioxide annually within the next three years. 

[UC Berkeley Professor of Civil & Environmental Engineering Jamie] Rector believes the site could store at least 100 million tons [of CO2] over its 40-year lifespan. The site’s compacted mud, silt, and clay, he said, would provide a natural cap that could keep the pollutant locked underground indefinitely, while its location alongside Bay Area industries would reduce carbon transportation costs.

Carbon capture and storage as a climate change mitigation strategy is not a new idea. Carbon capture has been used around the globe since the 1970s, and the projects generally come in two flavors: capturing carbon dioxide at the point of emission (point-source capture) or sucking carbon dioxide out of the ambient atmosphere (direct air capture). Once captured, the gases are pressured into a liquid and transported by truck or – more likely – by pipeline to the storage site. 

Researchers and organizations focused on climate change generally agree that some carbon capture and storage will be necessary to reach international climate targets. California may become especially reliant on CCS in order "to eliminate [the] millions of tons of greenhouse gases" needed to meet its carbon-neutrality mandate by 2045. Whether the state can meet these goals without exposing rural communities to localized environmental harms remains to be seen. Thus far, the dozen or so projects awaiting permits occur in largely rural and low-income communities (such as the CarbonTerraVault projects, which are pending permits for multiple carbon capture and storage projects in the San Joaquin and Sacramento Basins). 

A visual representation of CCS
Image Source: CO2GeoNet (Creative Commons license) (2025)

The extent to which communities will welcome the technology is another question. In western Kern County, CalMatters covered community response to a project designed to capture emissions at Elk Hills Oil and Gas Field and then "inject the gases more than a mile deep into a depleted oil reservoir." Elk Hills sits between the small Central Valley towns of Buttonwillow (pop. 1,2501) and Taft (pop. 7,000), about 30 miles west of Bakersfield. Covering the proposal for CalMatters, Alejandro Lazo writes:

Many residents and environmental justice groups oppose these projects because they allow oilfields, power plants and other industrial operations to keep emitting dangerous air pollutants in their communities. At the Kern County project, emissions of fine particles and gases that form smog would be 'significant and unavoidable,' according to the county’s environmental impact report.

On the other side of the conversation lies Dave Noerr, the mayor of Taft. According to CalMatters, Noerr "sees the technology as a gamechanger for Kern County: a way of hanging on to well-paying, middle class oil and gas jobs as California tackles climate change." 

Shuttered gas station near Taft, western Kern County
© Lisa Pruitt (2024)

New reporting from Grist and local news outlets suggest that support for the Montezuma project might be harder to come by. Environmental groups oppose the project for its location near sensitive wetlands habitat just beginning to realize the benefits of ecosystem restoration. Public health professionals cite concerns about leaks and continued exposure to polluting industry. 

The Montezuma NorCal Carbon Sequestration Hub is currently waiting on a permit from Solano County to build a test well. In its permit application, Montezuma Carbon claims the project will bring jobs, tax revenue, and cleaner air to Solano County. However, as proposed, the 45-mile carbon dioxide transport pipeline would run right by South Vallejo. Recent reporting by the Vallejo Sun highlights California EPA data showing that South Vallejo residents already deal disproportionately with poverty, unemployment, air pollution, and higher rates of asthma. 

Opponents frame Montezuma Carbon’s proposal as a question of who controls their land and who absorbs the risks of decarbonization. The county is home to roughly half a million people, including the Bay Area’s largest per capita populations of veterans and residents with disabilities, and it is among the most racially diverse counties in the nation. 

Conclusion

In many ways, the Montezuma Carbon project highlights systemic inequities and urban-centric values lurking in the corners of the energy transition. Success of CCS in California appears to depend (almost entirely) on rural counties and communities to host and accommodate these projects, now and forever. Their permanence raises questions about monitoring, the potential for future harms, and meaningful consent. Similar proposals have been shut down due community opposition in the Midwest (previous coverage of one such proposal on the blog), but the fate of many California projects remains to be decided.

Montezuma Hills between Suisun and Rio Vista
© Lisa Pruitt (2024)

Confederate flags in the rural non-south

I'm not quite sure how many times I've seen the Confederate Battle Flag being flown in rural California, but it is certainly more than I would expect outside the South. Given that Southerners often defend flying the flag as "heritage not hate," seeing it where there's no heritage to speak of is surreal. Then why fly the flag? 

 Media coverage on the topic rarely offers a compelling explanation. The articles typically follow a similar format, with interviews of the flag-waivers disclaiming racist intent countered with interviews of historians that emphasize the white supremacist character of the Confederacy. For example, NPR reports that Feeling Kinship With The South, Northerners Let Their Confederate Flags Fly, with the subjects sympathizing with the confederate cause of "fighting for states' rights, and the freedom to make their own way and to choose their own way against a tyrannical federal government."

The article highlights historian Rachel Jelks for the position that the flag represented defending the institution of slavery. But it frames this as merely an alternative view by introducing her simply as one of "many others" who believe this. Her credentials are mentioned, but the article does not seem to treat hers as the correct position. 

 Subjects frequently invoke current government overreach in justifying flying the flag. A Columbus Dispatch article has an Ohioan clarifying that the flag symbolizes his "distaste for the Federal Government." In their view, the war was primarily an issue of federal overreach, and so fly the flag as a stand against current overreach.

This reflects the mythological Lost Cause narrative of the Civil War, where slavery did not cause the conflict and the secession justified by the tyranny of the federal government. While directly contradicted by the historical record, it gained significant traction in the 20th century and became the default understanding of the Civil War for many. While the beliefs of the flag waivers are not out of the ordinary, it is still unclear why that particular symbol is utilized as opposed to other less inflammatory symbols.

These reports largely interpret the phenomenon as individualistic and fail to articulate any overarching theory. One exception is a 2022 article by David Graham in The Atlantic, which addresses the political divide on removing confederate monuments. He uses a contemporary poll to argue that "support for Confederate symbols and monuments follows lines of race, religion, and education rather than geography."

Graham finds through the poll that "non-southerners feel the same way about Confederate monuments that southerners do." What was once a regional difference had become nationalized. And he joins a number of other political scientists in identifying the urban-rural divide as the most significant political divide in our country today. 

Will Wilkinson is one of the more strident proponents of this theory. He supplements his 2019 report The Density Divide with a Substack article that argues that rural America has gone through "southernification." He acknowledges a lack of empirical evidence for this effect, but sees it as necessary to unify rural whites into a "single constituency."

A 2025 New York Times Op-Ed similarly argues that aspects of rural, country, and southern identity have all merged into a mainstream "rural" aesthetic that is exploited by populist politicians like Donald Trump. They go a bit too far with this approach by attributing too much of modern culture to this aesthetic, but they do accurately identify how Southern culture has become de-regionalized.

Simply looking at history reveals a simpler explanation. A Black Perspectives article highlights how activists donned Klan hoods and waved the Confederate Flag at an anti-civil rights event in the Bronx. In that context, it seems difficult to ignore the racist history of the flag in attempting to explain its modern usage outside of the South. 

Confederate Memorial Plaza, Anderson, Texas. 

Image Source: creativecommons.org 

NYS Agricultural Resiliency Against Tariffs Program: Is it enough to support the dairy and specialty crop sectors in New York?

On January 13, 2026, New York State Governor Kathy Hochul proposed the Agricultural Resiliency Against Tariffs Program, a $30 million initiative aimed at supporting farmers and agricultural businesses in New York hit by the ongoing effects of federal tariffs. The program is designed to provide direct payments to specialty crop growers, livestock producers, and dairy farmers—sectors that have often been left out of federal assistance programs.

According to the press release, these payments are intended to provide financial support that the USDA’s national relief programs fail to deliver, especially for specialty crops and dairy farms, which the announcement notes receive “no meaningful support.”

This statement likely references the Farmer Bridge Assistance (FBA) Program, a one-time federal relief program announced on December 8, 2025. While the FBA provides $12 billion in one-time direct payments to farmers nationwide, assistance is not available to dairy farms and merely $1 billion is available to specialty crops and sugar nationwide. Additionally, the FBA payments are capped at $155,000 per producer, limiting assistance for mid-size and large farms. With this context, Governor Hochul’s program attempts to fill a noticeable gap for New York farmers…but is $30 million enough to make a meaningful difference?

In New York, the dairy industry is the largest single segment of the agriculture industry. The nearly 3,000 dairy farms in New York produce the largest quantity of yogurt and cottage cheese in the United States and is the fifth largest dairy state. The dairy industry has seen significant change in New York over the past ten years, with the number of dairy farmers dropping from 4,955 in 2014 to 2,864 in 2024. However, over the same 10-year span, the average number of cows in the state has increased from 615,000 to 630,000. These statistics indicate that small farms are closing, and larger farms are increasing in capacity. This trend, known as farm consolidation, reflects broader pressured on family farms that are struggling to survive in a rapidly changing agricultural economy.

According to the New York State Tariff Disruptions Report, over 20% of a farmer’s income typically depends on exports. The report also highlights that over 80% of agrochemical imports and 70% of farm machinery are imported from countries subject to the administration’s tariffs. Farmers income reliance on exports may lead to heightened revenue volatility and retaliatory tariffs may raise production costs through raising the price of importing machinery, seeds, fertilizer, and other necessary equipment. Smaller farms that operate on thin margins often with less access to capital are left particularly vulnerable. If tariffs persist, these pressures could accelerate consolidation even further, leaving fewer, larger farms controlling even more of the state’s dairy sector.

To provide context for the Agricultural Resiliency Against Tariffs Program, there are approximately 2,800 dairy farms in New York state, not including specialty crop growers. When the proposed $30 million in direct payments is divided amongst just the dairy farms, each operation would receive roughly $10,000. Once specialty crop growers are factored in, the assistance will be significantly lower. While the assistance will likely be welcomed by farmers, will it be enough to make a meaningful impact? It may provide temporary relief in the industry, but any long-term benefits seem unlikely, especially with no end in sight of the tariff war.

 

Beyond immediate financial relief, the Agricultural Resiliency Against Tariffs Program demonstrates tension between state-level intervention and federal trade policy. Negative impacts from tariffs, such as increased input costs, are often disproportionately felt at local levels. While direct payments from the government can temporarily offset losses caused by retaliatory tariffs or increased import costs, they do not address underlying structural pressures. Smaller farms continue to face rising input costs, labor shortages, and operational challenges that may not be alleviated by one-time or short-term payments.

The central policy question is not merely whether $30 million is sufficient in the short term to bolster the dairy, livestock, and specialty crops sectors in New York, but also whether state-level relief facilitate industry resilience without broad reforms. Ultimately, state-level measures to support farms can mitigate, but not fully counteract, the effects of federal trade decisions.

Have rural American farmers voted against their own interests by voting for Trump in the 2024 election regarding Trump’s immigration policies?

Photo Credit: Larry Valenzuela, CalMatters/CatchLight Local (2025)

In the 2024 election, Trump had the most support from rural America, winning 93% of rural counties. Rural Americans have been supporting Trump since his first election in 2016 due to his pro-gun policies, tax cuts, and direct agricultural support. However, these supporters now face economic hardship, healthcare cuts, and agricultural harm with the new initiatives by the 2024 Trump administration. Additionally, the immigration enforcement by the Trump administration has led to ICE raids across farmlands, which has been detrimental to farmers. With mass deportation attacking immigrants, the agricultural business has been suffering because many immigrants come to the U.S. and are hired as farmers.

Earlier blog posts about Trump’s support from rural Americans and effects during 2016 here, here, and here.

Figure Credit: Pew Research Center (2025)

While immigrants do not make up an exceedingly large portion of the rural population, they do play an important role in the rural workforce, especially in the healthcare, agriculture, construction, and service industries. Additionally, rural areas need migration to prevent their populations from dying out, and many rural areas rely on immigrants – not only to keep the local economy afloat, but also to have stability in their populations. For this blog, I will only be focusing on agricultural workers, but I wanted to flag that immigrants come to America for all types of opportunities; Immigrants are more than just farmers.

Figure Credit: KFF; Authors: Drishti Pillai and Samantha Artiga (2025)

Pew Data research also shows that in general undocumented immigrants make up overall 5% of the US workforce and 53% of hired labor on farms. Agriculture seems to be the industry most reliant on undocumented workers. Farm owners have suggested that the only people showing up for employment on these farms tend to be immigrants. Farm owners do not care whether they are properly documented or not, because they need people who are willing to work. To be frank, undocumented workers are being exploited because of the fear of being “caught.” Undocumented workers will take a lower wage, no healthcare and social security in order to have any work available to them. They will take a job that is not paying them enough money to have a sustainable family lifestyle, just for the sake of having a job regardless. And farm owners would hire them because of that very reason, paired with the fact the immigrant workers are willing to do the manual labor. And the reality is “natural” American citizens do not want to be farmers anymore.

Consequently, many farmers voted for Trump, knowing that the immigration policies could potentially affect their employees. Many farm owners rely heavily on immigrants. Now, undocumented farm workers are afraid to show up to work, in fear of being caught by ICE and getting deported. There has also been an increase in self-deportations as well due to the fearmongering by the Trump administration, and undocumented immigrants not wanting to take the risk of being detained by ICE and potentially getting criminally charged (which would hurt any potential for becoming naturalized down the line). The agricultural economy depends on immigrants to help harvest the crops and send produce out to stores. The immigration policies and raids, while heavily affecting agriculture, is (in reality) affecting every Americans’ lives. The inhumane treatment of immigrants by ICE needs to be discussed, maybe then people will be more empathetic to what is happening by this administration. People are risking their lives to come work in the states, people who take the lower pay wages, and we need to protect those people.

If rural Americans were more aware of how these policies could have affected them, would they not have voted for Trump in 2024? That seems to be mostly untrue. While a few rural farmers may be regretting their vote, most are staying loyal to Trump saying that they think “tariffs eventually will make [them] great again.” Only some farmers have recognized that Trump’s immigration policies are hurting the American agricultural business. What will happen if Trump continues to ignore that rural America is dependent on migrant settlement and labor?

I'll end this blog with a quote from a dairy farmer from Wisconsin:

“We built an economy that relies on people, but we have a public policy that demonizes them” - Hans Breitenmoser discussing immigrant agricultural workers and Trump’s policies

Loving is radical: Rural America and political empathy

After winning the Grammy for Best Música Urbana Album the first thing Bad Bunny said was, “ICE out.” He then continued his acceptance speech with a simple but powerful call for love over hate, saying “we need to be different…we don’t hate them, we love our people.”

This call for loving more than we hate “the other side” stood out to me as what has been missing from the “rural versus urban” debate that consumes politics in the United States. As a self-described “liberal coastal elite,” if you had spoken to me after the 2016 election (when I was only 16) and again after the 2024 election, I would have told you, quite honestly, how much I hated the “other side.” At that time, the “other side” wasn’t limited to Trump or the political systems that enabled him to become president a second time. I meant anyone who voted for him and I was far from alone in that feeling.

“Rural bashing,” as described by Kaceylee Klein and Lisa R. Pruitt, refers to a phenomenon of “harsh criticism - even disdain...” towards rural voters or often all people living in so-called “red states.” While Klein and Pruitt detail that this is not a new phenomenon, they note that it has intensified in the Trump era. Importantly, this bashing isn’t limited to politicians or media, there are a multitude of examples of everyday people unable to feel empathy for those suffering in rural areas because “they voted for this.”

This bashing is further exacerbated by the tendency to equate “rural” with “white." In fact many who support liberal politics fall into the trap of believing that rural white people are the problem. While it is true that rural America votes predominantly Republican, as seen is the 2024 presidential election in which Trump won 93 percent of rural counties, believing rural America doesn’t deserve to benefit from any “liberal” policies or social systems is an uniquely unempathetic belief. As a condition of democracy, many believe that red voters should be held accountable for their actions, or in this case their votes, especially if and when those votes lead to unfavorable outcomes.

(c) Lisa R. Pruitt 2025.  

To be clear, I am not saying we need to have empathy for ICE, Trump, or the political and economic systems that have allowed racist, homophobic, sexist rhetoric to flourish. These systems deserve to be challenged, and when necessary dismantled. But when does hate for these systems turn into hatred for the people living within them?

Increasingly, politicians are beginning to realize that writing off rural Americans is not effective or sustainable. As Hannah Thomas has previously discussed on the blog, politicians like Bernie Sanders have been working actively to rally rural American voters rather than dismiss them. Even Hillary Clinton, in her The Atlantic opinion piece titled “MAGA’s War on Empathy,” reflects on her own struggle to feel empathy for people whom she passionately disagrees with. Although the piece, published just last week, may feel like too little, too late, it nonetheless underscores why the rhetoric of active politicians toward rural Americans must change.

If we are serious about creating political change, we must shift our strategies. Active politicians, media, and everyday liberals alike must take note of what is driving us. If the driving force is hate for the “other side” in the form of rural Americans, we will continue to live in a divided America.

Rural immigration: then and now

  The image conjured up from the mention of rurality likely resembles Grant Wood's 1930 painting "American Gothic." The piece shows a man and a woman, two thin, tall looking, presumably Anglo-Americans standing in front of a farmhouse and a piece of another red structure. The man holds a pitchfork, and both the man and woman bear stern expressions imparted to them by the Great Depression. In the imagination of most people, the rural American is a white farmer, without much thought as to the particular ethnic origin or religious denomination of such white farmers.  

We often forget that the ancestors of people like those depicted in "American Gothic" were once immigrants too. Much like the likely unused farmhouse in the picture, the material conditions shaping early immigration to the American countryside have faded, leaving behind echoes of the past.  Rural residency is increasingly no longer defined by yeoman land ownership. 

Along with commercialized agriculture, rural lands find themselves appropriated for newly discovered uses. Particularly with oil and natural gas harvesting, economic diversification comes opportunities for labor and ethnic diversity. While the workers in the PBS video linked are not immigrants to America, they are as though immigrants to rural spaces. In a way, it's the same story as the rest of America's history on the frontier and the spatial gaps waiting to be filled. 

I. How the timing of migrations result in the present-day makeup of most rural communities. 

The Homestead Act of 1862 radically changed the demographic landscape of American territory from the still-sparse Midwest to the Pacific Ocean, especially those sparsely settled territories in the Great Plains region. The act was accommodating toward immigrants at the time, where the "37th Congress intended the Homestead Act as a way to bolster a stagnant population and build an agricultural nation through immigration and the settlement of the public lands of the United States."  Of course, the Homestead Act's preceding efforts found opposition, as "Northern factories owners feared a mass departure of their cheap labor force and Southern states worried that rapid settlement of western territories would give rise to new states populated by small farmers opposed to slavery." The temporary exit of the southern states from the United States made the long-awaited Homestead Act a reality. Newly arrived German immigrants would take a significant portion of the land grants available, along with already settled Anglo-Americans and newly arrived Irish immigrants. As can still be observed by ongoing census statistics, German immigrants fleeing from turmoil within the not-yet united Germany now make up the lion's share of these communities. It's worth noting that even up to World War One, German-Americans themselves were still considered a type of ethnic minority. The frontiers, then as now, were a way for the marginalized to find more opportunities forbidden to them on settled shores. 

The echoes of migration patterns from Europe to the United States can be directly observed with the help of the US Census Bureau's My Congressional District interactive site. For example, a search for Idaho District 2 will show a variety of metrics for the population of the district, including ancestry. English (186,185) and German (138,240) outstrip all other ethnicities, with Irish (81,549) coming in a distant third. Next-door in Oregon's rural District 2, we see similar numbers with German, English, and Irish Americans far outstripping every other ethnicity. In Kansas's rural District 1, the contrast is more stark with German-Americans (195,377) outnumbering English-Americans (67,604) and Irish-Americans (79,082) combined. In Iowa, the scene of "American Gothic," German-Americans outnumber Irish-Americans, the second most populous ethnicity of the state, by a ratio of two to one in all four Congressional districts. The sheer demographic weight of German immigration was felt as far as in formerly Spanish California, where the city of Anaheim, the tenth largest city in California and home of Disneyland, was founded in 1857 as a colony of German farmers and vinters, although the vineyards were soon replaced by citrus groves. 

German-Americans, whose ancestors immigrated alongside Irish-Americans right on time for the frontiers to open for settlement, number among the top three ethnicities for most rural districts, alongside Irish-Americans and English-Americans. Italians, East European Christians and Jews, and Greeks arriving around the 1890s missed their opportunity to take advantage of the homestead act, so they mostly settled in the larger cities. 

[Feel free to ignore this. I thought this was an interesting further breakdown of the European ancestry groups of rural America east of the Midwest. The German-American predominance in rural communities appears to halt once hitting Appalachia. In Kentucky's 1st District, English-Americans (95,889) outnumber German-Americans (69,030). Further east in Kentucky's 2nd District, the ratio rises to above two English-Americans (107,759) for every German-American (48,809). Further east in West Virginia's 1st District, within the bounds of America's original 13 states, we see German-Americans (84,681) again outnumbered by both English-Americans (142,824) and Irish-Americans (91,090). West Virginia's 2nd District, which is adjacent to Southwest Pennsylvania, has a plurality of German-Americans (154,652) outnumbering English-Americans (118,480) and Irish-Americans (123,287). Contrary to popular perception, the Scotch-Irish number only 15,067 and 12,822 in Districts 1 and 2 of West Virginia, respectively. In the far Southwest corner of Pennsylvania, Congressional District 14's German-Americans (179,027) massively outnumber English-Americans (73,661) and Irish-Americans (109,698). Even east of the Appalachian Mountains in PA's District 9, German-Americans hold an even more convincing plurality (209,396) over English-Americans (65,231) and Irish-Americans (92,200). However, just one district over in the significantly more urban District 8, German-Americans (113,212) are outnumbered by both Irish-Americans (136,548) and Italian-Americans (114,220).]

[Looking at rural, agrarian Vermont on the other side of the United States as a control, we see different numbers. Irish (119,423) and English (117,946) predominate Vermont with German (72,670) coming in third if French (53,628) and French-Canadian (39,718). The next most populous group in Vermont are Italians (51,200). New Hampshire tells a similar story, with Irish and Italian populations outpacing German populations. German-Americans find themselves without a plurality in most of Virginia's districts, North Carolina, and South Carolina, but still close to Irish and English population levels.]

From the sample states mentioned, rural America is mostly dominated by English, German, and Irish Americans. Although each group is considered white, a proposition which would make Benjamin Franklin spin in his grave albeit relieved of his concerns that the Germans would not learn the English language, I would argue that each carry with them historical distinctions within the context of American history. To clarify, English-Americans are the same stock as the Founding Fathers. While many Englishmen did immigrate to the United States in the 1800s, they did not need to assimilate to the same degree that German and Irish immigrants were expected to assimilate, so they don't necessarily share the same experience most immigrants had.  

II. The evolving situation

The conditions which led to the initial population of the American countryside have largely been undone. Roughly 40 percent of nonmetro counties reached peak-population in the 1950s before experiencing ongoing population decline. Small-scale agriculture continues to decline in profitability. Manufacturing, arguably more important to the rural economy than the urban economy, saw employment fall by nearly 30 percent between 2001 and 2015. Rural communities find themselves disinvested of schools for their dwindling youth demographic. Where rural communities are losing native-born population, minorities and immigrants have risen to the occasion to fill the gaps. In Juleberg, which is located in the Northwest corner of Colorado, one immigrant math teacher stepped in when no American math teacher would take the vacancy. In more communities than rural Colorado, schools have looked overseas to fill teaching vacancies. Where Americans are unwilling to move to work positions in rural locations, it counterintuitively turns out that immigrants will. In Depopulation, Deaths, Diversity, and Deprivation: The 4Ds of Rural Population Change, Daniel Lichter and Kenneth Johnson shed light on surprising population trends surrounding the simultaneous depopulation of rural communities and the immigration toward rural communities. While, according to the 2020 Census, 76 percent of the non-metropolitan population is white, "nearly two-thirds of all rural population growth was due to Hispanic population growth," not that the growth fully compensated for the total loss in population of nonmetro counties. However, interpreting the data another way, immigration to rural communities may be cause for hope. If most of the population loss is from old age deaths, and presumably most immigrants to rural areas are young, working-age adults, it stands to reason that there's a possibility that they may form families in these areas. And as noted in the PBS video on natural gas fracking attracting a diverse array of workers, people are less likely to move away when they have children.  

                                                        Credit: Daniel Lichter, Kenneth Johnson

Though working with far fewer grants and benefits than what German and Irish immigrants received, Hispano-American and Filipino immigrants are helping to revitalize America's old and new frontier in rural communities. 

III. Conclusion

The more things change, the more they don't. In the same way that the United States government, in part, relied upon German and Irish immigrants to settle the not-yet cultivated lands of the Midwest and beyond, the current United States government may learn lessons from the past. While a modern-day Homestead Act, in its exact prior iteration using federally held lands, is unlikely to succeed due to the ongoing difficulties presented to non-commercial small-scale agriculture, the expansion of internet and electrical infrastructure to rural communities may see a different type of artisanal, non-land dependent, economic growth.