July 31, 2026 | Alice J. Schenall, Bonita Robertson-Hardy
Rural communities are essential to the health, economic vitality, and resilience of the nation. Yet many rural areas continue to face persistent barriers that affect both health outcomes and quality of life — including workforce shortages, limited access to care, constrained public health capacity, and challenges securing sustainable investments.
Addressing these complex issues requires approaches that move beyond traditional sector boundaries and strengthen connections among public health, health care, economic development, education, philanthropy, and community leadership.
Collaboration at the Rural Health Academy
To support this work, ASTHO hosted the second Rural Health Academy, bringing together a small group of state health officials for collaborative learning, peer exchange, and strategic discussion focused on advancing rural health. The Rural Health Academy is designed to strengthen connections between state leaders and federal partners, identify promising practices, share resources, and explore funding opportunities that can support rural communities. Through a dedicated network focused on rural public health, the initiative also seeks to better understand state priorities and inform future technical assistance and engagement strategies.
The Academy recognizes that improving rural population health requires more than addressing health care delivery alone. Discussions focus on:
- Strengthening the rural workforce.
- Aligning funding and incentives.
- Expanding data sharing.
- Creating cross-sector partnerships. Integrating clinical care with social and public health systems.
- Establishing shared accountability measures.
By emphasizing relationship-building and collaborative leadership, the Rural Health Academy helps equip state health leaders to advance innovative strategies that improve health and well-being across rural communities.
Aligning Systems to Improve Rural Health Outcomes
A central theme emerging from conversations among state health leaders and rural development practitioners is the need to bridge the longstanding divide between rural public health and rural health care.
Health care systems play a critical role in diagnosing and treating illness, yet many of the factors that shape health outcomes occur outside clinical settings. Challenges such as housing instability, transportation barriers, workforce opportunities, food access, broadband connectivity, and educational attainment often have a greater influence on community health than health care services alone. At the same time, public health agencies frequently operate with limited resources and face difficulties coordinating with health care providers, community organizations, and development partners.
The result is a fragmented landscape in which organizations often work toward similar goals but through different funding streams, accountability structures, and planning processes. Rural communities can find themselves navigating multiple initiatives that address individual issues while lacking the coordinated, long-term investments needed to improve overall community well-being.
At the same time, encouraging signs are emerging across sectors:
- Elected officials and economic development leaders are increasingly recognizing that health is an important component of economic prosperity.
- Philanthropic organizations are exploring more comprehensive approaches that move beyond single-issue investments.
- Government agencies are seeking ways to better align programs with the unique needs of rural communities and support regional capacity-building efforts.
These shifts create new opportunities to connect rural health transformation efforts with broader community and economic development strategies.
Rural Development Hubs: A Promising Strategy
One model gaining increasing attention for its ability to bridge sectors and accelerate community well-being is the Rural Development Hub. First outlined by the Aspen Institute Community Strategies Group in 2018, the Rural Development Hub model reflects decades of learning from rural practitioners, community leaders, and regional organizations working to create transformational change. Rather than focusing on a single program or issue area, Rural Development Hubs serve as place-rooted organizations that help coordinate partners, build local capacity, and connect community priorities with resources and investment.
A Rural Development Hub may take many forms. It can be a nonprofit organization, Tribal entity, community foundation, educational institution, local development organization, or another trusted, community-based institution. What distinguishes a Hub is not its organizational structure but the role it plays within a region.
Like the hub of a wheel, these organizations connect people, organizations, resources, and opportunities that might otherwise remain disconnected. Because many rural challenges cross municipal and county boundaries, Hubs often operate at a regional scale, helping communities work together toward shared goals and attract investments that benefit multiple jurisdictions.
Several characteristics distinguish successful Rural Development Hubs:
- They work across both geographic boundaries and issue areas.
- They are deeply rooted in the communities and regions they serve.
- They prioritize collaboration and capacity-building.
- They address both immediate community priorities and broader systemic challenges.
- They are willing to take and manage risk when other institutions may be constrained.
- They convene partners across sectors, including health, workforce development, education, infrastructure, economic development, and human services.
These characteristics closely align with priorities identified through ASTHO’s Rural Health Academy. As state health leaders seek ways to strengthen cross-sector partnerships and improve population health, Rural Development Hubs offer a practical framework for connecting health care and public health investments with broader community development efforts.
Examples in Action
Across the country, Rural Development Hubs are demonstrating how coordinated regional leadership can improve health outcomes while advancing broader community well-being.
MDC’s Rural Forward Initiative (North Carolina) works with rural communities to strengthen economic opportunity, leadership development, and community prosperity. Through regional collaboration and local engagement, the initiative supports communities in addressing interconnected challenges that influence health and quality of life.
Kansas Health Foundation (Kansas) has supported partnerships that connect health improvement efforts with community development strategies, helping communities build stronger relationships across sectors and create conditions that support long-term well-being.
Imperial Valley Wellness Foundation (California) focuses on advancing community wellness through initiatives that address health, economic opportunity, and quality-of-life outcomes. By bringing together diverse stakeholders, the organization helps align investments and regional priorities to support healthier communities.
These examples illustrate a common lesson: Health outcomes improve when health care systems, public health agencies, community organizations, businesses, educational institutions, and local leaders work together around a shared vision for community well-being.
Looking Ahead
As rural communities continue to navigate workforce shortages, economic transitions, and persistent health challenges, solutions will require stronger alignment between health care, public health, and community development. The Rural Health Academy provides an important forum for state health leaders to explore these connections, identify practical strategies, and strengthen partnerships that can advance rural population health.
At the same time, Rural Development Hubs offer a proven framework for coordinating efforts across sectors, building regional capacity, and creating the conditions necessary for lasting change. Together, these approaches can help bridge the gap between rural public health and rural health care — advancing healthier, more resilient, and more prosperous rural communities for generations to come.
Reviewed by Avia Mason, Vice President, Leadership and Learning.
This project is supported by the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services (HHS), Office of Rural Health, as part of a financial assistance award totaling $200,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.
