People in rural America are five times as likely to live in so-called "ambulance deserts," areas far from an ambulance service or station, than those in urban areas.

In rural Iowa, ambulance service has declined as the population dwindles. The study, from the Maine Rural Health Research Center, said half of those living in ambulance deserts are in rural areas, more than 25 minutes from an ambulance station.

Keokuk, along the banks of the Mississippi in eastern Iowa, has seen its population shrink to fewer than 10,000, with a sharp decline in ambulance service.

Cole O'Donnell, city administrator, said the situation got worse when officials were forced to close the local hospital.

"It frightened a lot of people," O'Donnell recounted. "I know that we have older people that moved out of Keokuk to someplace closer to a hospital. You know, they had health problems and if something happened, they couldn't wait those extra minutes, or even the extra minutes of getting them from Keokuk to a hospital."

In addition to trying to bolster county ambulance service, O'Donnell noted Keokuk is working to help reopen the local hospital as a federally designated Rural Emergency Hospital, which requires the facility to provide emergency services and outpatient care 24 hours a day, 7 days a week.

Emergency medical service is not considered essential in rural America, and the federal government does not fund it. Volunteers form the backbone of E-M-S operations in many areas, including Iowa. But O'Donnell acknowledged in Keokuk, times have changed. It is hard to find paramedics and emergency medical technicians, let alone people who do not get paid to do those jobs.

"When I was growing up in the '70s and the '80s, my mom was even part of the first responders," O'Donnell explained. "You can't even get first responders now to set up a service where they respond before the ambulance gets there, because nobody wants to volunteer anymore."

While about 14% of Americans live in rural areas, the report shows they make up more than half the population living in ambulance deserts.

Work is being done in rural areas across Texas to make sure students are prepared for the workforce even if they intend to stay put after graduation.

One new study showed only 31% of adults in non-metro areas have a degree from a junior college or university. The nonprofit Jobs for the Future creates opportunities for the education system and local businesses to work together in hopes of increasing the number.

Sarah Jenness, senior manager of the group, said there are three key changes leaders in rural areas could make to improve training for students.

"Strategy number one, build on your local strengths and contacts," Jenness outlined. "Strategy number two is thinking about how to prioritize inclusive economic development. And then finally, the third strategy was around embedding remote opportunities."

Jenness argued schools, local economic development agencies and businesses need to collaborate to create opportunities. A couple of options are dual enrollment, where high school students also earn college credits, and work-based learning, so they can hone their skills on the job.

The study found in the U.S., the benefits of economic systems are unevenly distributed and certain groups and communities suffer the most, particularly rural areas. Disparities are also seen across lines of race, ethnicity and gender.

Jenness stressed gaps can be closed if rural students receive training for the types of jobs available in their communities.

"What are the industries that employ the most rural workers? And the top three that we think tend to be -- you know, have good quality jobs -- are industries like government, manufacturing and health care," Jenness explained.

She added remote work is also a key strategy to ensure rural students have access to a variety of well-paid jobs.


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A lack of staff and know-how often means rural towns miss out on grants to improve their communities, and a Texas group is trying to balance the scales.

Billions of dollars will soon be flowing from the federal government to states for broadband, water and energy upgrades, transportation infrastructure and other projects. To help rural towns and nonprofits secure the money, Texas Rural Funders has stepped in.

Kelty Garbee, executive director of the group, said their online grants hub includes a list of grants available to rural groups.

"I regularly receive calls saying, 'We need to upgrade our fire station or our school is looking for support for a particular project,'" Garbee explained. "It's very overwhelming to figure out where to find grants in the first place."

Garbee noted about 50 federal and state grant opportunities are listed on the website, along with grant writers who can be hired to assist rural governments or organizations with applications. She explained the Hub preselects grants for which they know rural areas are eligible.

She pointed out essential needs in small towns to often go unfunded because of limited tax revenues. She hopes resources on the hub's website will give small communities a leg up.

"Often in a rural community, one person has so many jobs," Garbee observed. "What we've done is vet the grant writers. They'll send in work samples of grants they've written so you can actually download this roster of grant writers."

Texas is expected to receive about $2.5 billion for water infrastructure through the Infrastructure Investment and Jobs Act. As the state with the largest rural population, it also will receive billions in federal dollars in broadband infrastructure grants.


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The Rural Advancement Foundation International is taking action against food injustices impacting farmers of color and rural communities through its Farm and Faith Partnerships Project.

In North Carolina, about 1.2 million people face food insecurity, and 394,000 of them are children.

Jarred White, Farm and Faith Partnerships project manager, said the Farm and Faith Project sprouted during the pandemic, responding to challenges of food insecurity and racial land loss.

"We hope that these relationships result in farmers of color gaining additional sources of income and increased access to new local markets," he said, "and rural faith community members and other community members gaining increased food security and access to fresh healthy foods."

Through partnerships with local faith communities and organizations such as The Duke Endowment, he said, congregations are forming local food-box purchasing groups or hosting farmers' markets in their parking lots. He said this type of work helps farmers of color who grapple with systemic racism in the food system.

Black farmers own less than 1% of the nation's farmland compared with about 95% of farmland owned by their white counterparts. According to Data for Progress, Black farmers face challenges getting loans, are often denied credit, lack access to legal defense against fraud, and are under threat of violence and intimidation.

Over time, White said, these factors have made it challenging for many to sustain their farm land.

"Farmers of color often have less access to markets, fewer beneficial relationships, and fewer financial resources and opportunities," he said, "which all results in higher rates of debt, lower land ownership rates."

In addition to fostering mutually beneficial connections to enhance food networks across the state, White said there are environmental advantages, too. He highlighted that supporting local farmers reduces greenhouse-gas emissions and minimizes the impact of transporting food over long distances.


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