About one-third of Missouri is considered rural, and people who live there often have health challenges. The latest research suggested overlooking rural areas has major consequences.

A new report from the Missouri Rural Health Association outlined the need for continued investment in rural Missouri.

Katie Reichard, director of government affairs for the Missouri Primary Care Association, said many factors contribute to worse health outcomes in rural communities but access to care is at the top of the list. Community health centers help close the gap, seeing patients no matter their ability to pay, and helping those who might otherwise end up at hospitals for nonemergency needs.

"You don't have to go to the hospital for a toothache or strep throat; a community health center can provide those services to you, "Reichard explained. "It's on a sliding fee scale and so, it's income-based. Also, they cover behavioral health services, a lot of them cover women's health services, and all of them cover primary care and dental."

According to the report, for the first time ever, Missouri recorded more deaths than births during the pandemic. It caused a 19% increase in deaths for Missourians overall, and decreased overall life expectancy by more than two years.

Heidi Lucas, executive director of the Missouri Rural Health Association, thinks investing in rural areas of the state is imperative not only for Missouri, but for the nation.

"Rural Missouri is America's breadbasket," Lucas pointed out. "We have some of the highest producers of grain and cattle in the entire country, so we really need to take care of folks who are living in rural Missouri, because they are providing for America, widely."

Missouri is home to more than 95,000 farms, the second-highest number in the U.S. It's also the second-largest producer of hay and is second-highest in the nation for beef, with more than 2 million head of cattle.

Lucas added while the report identifies areas of concern, there are many solutions.

"Upping broadband to have more telehealth services; reducing restrictions on providers so that they're able to provide more widely to the full extent of their education and training; finding preceptors for nurses or physicians; getting transportation taken care of, to get there," Lucas outlined.

Lack of affordable health care affects more than farmers' personal health, according to a Missouri Rural Crisis Center report. It also causes financial strain and delays in farm investments.

Several rural communities across North Dakota are strategizing how to slow the pace of local grocery stores shutting down.

Some are making use of state grant money to aid their efforts, but challenges remain.

In North Dakota's Walsh County, the Rural Access Distribution Cooperative has been on the leading edge of establishing local grocery store co-ops, where a handful of smaller shops buy items in bulk together.

The initiative was eventually awarded a state grant to buy a bigger truck and van, making supply deliveries more manageable.

Cooperative President Alexander Bata said they continue to see progress with increased sales, and better options for area residents.

"So, there's less waste, less cost," said Bata, "and we've significantly improved the quality of food."

However, other elements of the initiative still face hurdles.

That includes utilizing food lockers, where customers can buy their food online and pick it up when they choose. But Bata said they haven't been able to make the technology work.

In 2023, the Legislature approved $1 million for interested communities to sustain grocery service in smaller towns with limited access.

The town of Milnor, with a population of around 600, was one of the early grantees - and used its money for a feasibility study.

Milnor's Community Economic Development Coordinator Carol Peterson said those findings were clear - their lone grocery store needs more storage space to stay afloat.

"It makes it very hard," said Peterson, "to order in enough product to service the community."

That limits the store from keeping prices lower.

Peterson said she worries more customers will then look at far away options, taking their tax dollars with them. While local leaders did get a read on what's needed, they haven't been able to secure additional funding for the next phase.

A key legislative sponsor of the pilot grant program says there's interest in extending it next session, but she's still gathering feedback.


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The American Postal Workers Union is pushing back against proposed changes to the Postal Service they said would slow delivery.

Among other things, the proposal aims to cancel afternoon deliveries and pick-ups for areas more than 50 miles from a regional hub. Postmaster General Louis DeJoy said elimination of night pickups could save the post office more than $3 billion a year.

Daniel Cortez, director of industrial relations for the Oregon Postal Workers union, said reducing services does not make sense financially.

"To think that eliminating services, reducing standards, basically providing the American people with less reliable service is somehow going to make money, it's nonsense," Cortez contended.

The charges are the most recent in a series included in Dejoy's 10-year "Delivering for America" plan. The union said DeJoy, who was appointed under President Donald Trump, has already raised prices for stamps while closing post offices across the country, especially in rural communities.

Cortez noted although rural communities would be hit hardest by this latest proposal, urban centers will also be affected. He explained the Postal Service has been shutting down processing centers in the state, making Portland the sole distribution site for all of Oregon, which means more mail delays for everyone, including Portlanders.

"If the clerks and the employees in the main plant are processing mail for the rest of the region, that means they're not at that same time processing Portland's mail," Cortez emphasized.

The changes come as first class mail volume has fallen 30% in a decade, with fierce next-day delivery competition. Although the Postal Service said under the new proposal most first class mail will not be affected, Cortez argued management is already failing to meet its lowered delivery standards from 2021. He added mail never used to sit around.

"First class mail was always moving until it got to where it needed to go," Cortez recounted. "That's just what everybody understood about the service that we're required to provide to the American people."

North Dakota has 30 available workers for every 100 open jobs. To help confront workforce shortages, the state is now accepting grant applications to kick-start solutions at the local level.

The Department of Commerce's Regional Workforce Impact Program invites towns, cities and their business development groups to seek out the grants.

Arik Spencer, president and CEO of the Greater North Dakota Chamber of Commerce, said providing seed money to foster innovation in worker recruitment might boost rural areas at a competitive disadvantage.

"Whether it is starting manufacturing ventures or doing other creative things," Spencer outlined. "To the extent that this can help those, maybe, small communities or underserved communities get people to move there and bolster their workforce, we think that's a positive outcome."

Spencer pointed out the innovation might look like closing affordable housing gaps, which he said is a common roadblock around the state. He and other stakeholders monitoring the labor landscape still hope for broader support when the Legislature reconvenes early next year. North Dakota's labor shortage woes appear to be more pressing than its neighboring states.

Spencer noted no matter the size of the community, applicants appear to be in the driver's seat in coming up with fixes that work for their populations.

"While living in Fargo may be attractive to some people, maybe living in Watford City's attractive to others," Spencer acknowledged. "This grant program allows those regional communities to figure out their own solutions and tackle those with the support of the state."

The application period began this week and runs through Jan. 21. There are grant caps for certain categories. For example, a local coalition focused on recruiting talent can receive a grant of up to $250,000. The cap is higher for infrastructure needs related to worker recruitment, such as child care centers.


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