Stories

The rural America death spiral

Illustration of a tractor plowing a field in the shape of a heart monitor that is petering out
Illustration: Sarah Grillo/Axios

Many of the nation's current pathologies are taking a heavy toll on the majority-white population living in rural America, which was severely impacted by the opioid crisis and has dealt with falling populations, job losses and rising suicide rates.

Why it matters: The malaise and discontent that President Trump has tapped into goes beyond the racism we've seen over the past few weeks and includes anger at a changing world and frustration at dwindling opportunities close to home. These trends are further entrenching the rural-urban schism that came to light in the 2016 election.

The big picture: Political and economic power is shifting to the cities, and 20% of the population — about 60 million people — is being left behind in the middle of America. These communities face increasingly difficult barriers to education, wealth and health.

  • And if you're African American or Hispanic, your chances of success and survival at every turn are even worse.

Let’s say you were born, grew up and now reside in rural America. Throughout your life, you have been more susceptible to poverty, lower education, illness and even death than your urban counterparts.

  • As a kid, chances are, you lived farther away from a doctor or hospital and got less exercise.
  • You were more likely to live in a school desert — having to travel long distances to make it to school, if you were able to attend at all. Your school might have shuttered, as school consolidation has become more common in many rural areas, per the New York Times.
  • You had a greater likelihood of getting your high school diploma than the national average, but were far less likely to go straight to college than your urban and suburban counterparts, as The Atlantic reported.
  • If you did graduate with a college degree, you'd likely end up so saddled with student debt that returning to your rural hometown wouldn't be an option if you hoped to get a job that would enable you to pay it off, according to research by the Federal Reserve.
  • Even if you stay, some of the brightest people you grew up with would leave, contributing to the rural "brain drain."
  • As an adult, you’re more likely suffer from obesity, mental health issues, diabetes, cancer and opioid addiction. You are more likely to know people who took their own lives.
  • If you keep working in your hometown, your job is more likely to be taken over by AI, according to a study by the Brookings Institution — especially if you live in Indiana, Kentucky, South Dakota, Arkansas or Iowa.
  • Your community's economy still hasn't fully recovered from the 2008 recession, according to Fed data.
  • As you get older, you are more likely to die from a preventable death, according to the Centers for Disease Control and Prevention.
  • If you do make it into old age, you may not have a place to grow old near your friends, family and the place you called home your whole life.

What's next: Technological advancements such as 5G and automated vehicles won't directly make life harder for rural America, but instead will fuel inequality by making life that much easier for urban America.

  • The rural-urban divide will continue to play a central role in politics and elections for the next several years — unless and until rural America's population declines enough that its political power dwindles.

The bottom line: States, municipalities and the federal government have spent billions to draw jobs and prosperity to stagnant rural areas. But not much has changed.

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Editor's note: This story has been corrected to reflect that 20% of the U.S. population is about 60 million people, not 46 million, as previously written.