Governors and States are Advancing Equitable Rural Economic Development and Healthcare

Supporting rural communities is a top priority for Governors, and states and territories are working to advance solutions in this area, particularly with respect to economic development and healthcare. More than 90% of the country’s land is considered rural, and one in five people in the U.S. live in rural places. One in four people in rural areas are people of color, underscoring the diversity of the rural population.

The National Governors Association Center for Best Practices (the NGA Center) has engaged in this work through the Toward Better Rural Futures project, coordinated by ChangeLab Solutions in collaboration with the Praxis Project, and with funding from the Robert Wood Johnson Foundation. This work is also part of a nationwide coalition of organizations called “Thrive Rural” which is supported by the Aspen Institute’s Community Strategies Group (CSG). The Toward Better Rural Futures project seeks to address the systemic and structural barriers and chronic disinvestment impeding rural and tribal communities’ health, well-being and opportunity, thereby perpetuating deep-rooted inequities.

The NGA Center recently hosted two virtual roundtables focused on this topic, one on equitable economic development and one on equitable healthcare for rural communities. These events served as a bipartisan discussion space for thought leaders committed to advancing rural equity, including stakeholders at all levels of government as well as practitioners and experts from associations, nonprofits and other organizations. Roundtable participants shared best practices and discussed high-impact policies that Governors and state leaders are using to advance economic and health equity for communities across rural America. These conversations resulted in policymakers debating and finding common ground in several rural equity policy areas as well as identifying ways to foster greater collaboration across different levels of government to advance those policies. This commentary summarizes the themes and key takeaways from both roundtables which states may incorporate into their larger rural policy framework and which other stakeholders may leverage to advance equity, health and economic opportunity for rural communities.

Equitable Rural Economic Development Roundtable

At the Equitable Rural Economic Development Roundtable held on February 23, 2023, Aspen CSG Co-Executive Director Chris Estes presented the Thrive Rural Framework to kick off the first round of discussions. The Framework is a living tool that people can use to spark new ways of thinking and acting to promote rural prosperity. It is designed for those working in communities as well as policymakers and practitioners focused on economic development and other issues.

During the roundtable discussion sessions, state participants agreed on the importance of having a single state-level office or center for strategically aligning state agency efforts, policies and resources to better serve rural communities. States that are creating or who recently established rural offices include Illinois, Indiana, Iowa, Kansas, Michigan and Wisconsin. Other states, such as North Carolina, have statewide nonprofits focused on rural programs. The North Carolina Rural Center is supported by the state’s Department of Commerce, for example, among numerous other public and private investors and supporters. Based on the many state examples highlighted in the discussions, it became clear that state rural offices and programs are helping to build rural capacity and contributing to useful interaction between the federal, state and local government. They are also addressing the significant workforce challenges in rural areas.

The Kansas Office of Rural Prosperity is part of the state’s Department of Commerce, which focuses a number of its successful economic development strategies on the state’s rural regions. Unique initiatives like Network Kansas and Economic Gardening allow the state to help rural entrepreneurs access startup capital, market-research data, geographic information systems and other commercially available databases. Kansas also offers incentives through its Rural Opportunity Zones program and student loan repayment assistance for individuals who move to rural areas in the state. Trisha Purdon, Director of the state’s Office of Rural Prosperity, highlighted these and other strategies:

  • Expanding partnerships to build capacity and to help rural communities apply for funding;
  • Addressing childcare needs to increase rural workforce participation;
  • Revitalizing and marketing rural buildings so rural communities are development-ready;
  • Establishing Land Bank Trust funds and Moderate-Income Housing programs and
  • Offering state-level tax credits for historic preservation and community service to support rural food banks, rural childcare and other programs.

Participants also heard about Kentucky’s rural initiatives, which have included significant recent infrastructure investments in drinking water and a broadband deployment fund for prioritizing underserved areas in mainly rural communities. Kentucky Governor Andy Beshear’s Washington Director Coulter Minix noted the Governor’s active role in rural policy this year as Co-Chair of both the Appalachian Regional Commission and the NGA Economic Development and Revitalization Task Force.

Albino Garcia, Executive Director of La Plazita Institute in Albuquerque, New Mexico, represented the local grassroots community perspective as the final speaker. He reminded the group that inclusion-informed policy comes in stages that only just begin with engagement. He noted that moving beyond simply engaging rural residents to including them in policy development and reconciliation helps to produce well-meaning policies that can become institutionalized over time.

“We’ve welcomed new businesses and jobs to Western and Southeast Kansas. We’ve invested in rural housing. We’ve expanded high-speed internet. All of that work has been essential, and we’ll continue to do it.”

Governor Laura Kelly

Equitable Rural Healthcare Roundtable

The roundtable on equitable rural healthcare, held on March 2, 2023, centered on presentations and discussion around ways to advance healthcare access and bolster the healthcare workforce in rural communities. Two speakers from the Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy presented on the office’s work to support rural policy. HRSA collaborates with rural communities and partners to support community programs and share policy ideas to improve health in rural America. HRSA also provides cross-agency collaboration, capacity building and serves ass the voice for rural communities within the U.S. Department of Health and Human Services.

Participants discussed several policies state leaders might consider to address these healthcare issues, including ways to increase access for health insurance coverage for rural communities, options to include paid family and medical leave, and ways to expand or maintain telehealth and consider its role in rural communities. Key themes from the discussion included:

  • Framing healthcare as an economic issue;
  • Interagency collaboration to coordinate initiatives;
  • Promoting a “grow your own” strategy by supporting and investing in existing rural community structures and
  • Providing better pay and reimbursement for on-the-ground healthcare workers, like community health workers, without putting undue burden on these workers.

Much of the conversation related to healthcare workforce shortages and issues, segueing into the second discussion of the day. To set the scene for this discussion, speakers from Wyoming and Colorado presented information on their rural healthcare workforce challenges and related initiatives focused on expanding and strengthening this workforce.

First, Jen Davis, Wyoming Governor Mark Gordon’s Senior Policy Advisor for Health and Human Services, described workforce challenges, including the fact that the state does not have a medical school, and the challenges of providing care in a rural, low density population area. Wyoming is expanding its pipeline for certified nursing assistants (CNAs) and using labor market data to prioritize efforts.

Next, Jarett Hughes, Colorado Governor Jared Polis’ Deputy Director of Policy and Research, described the changing demographics of rural Colorado. Current rural workforce initiatives include focus on the community college and four-year higher education institutions across Colorado. The Colorado State University Extension Office, which leverages the existing statewide extension network to engage local leaders and community-based organizations (CBOs), the Colorado Rural Health Initiative created through SB22-172 and the zero-cost community college credential program launched by SB22-226 were among the highlights.

Participants discussed policies for consideration and use as best practices, including recruitment and retention policies such as student loan repayment and scholarship programs, licensing policies, Health Enterprise Zones, workforce data collection and analysis, and healthcare provider cultural competency and responsiveness training. The key takeaways from the discussion included:

  • Creating an environment where people want to live and work, particularly in the healthcare sector;
  • Streamlining occupational licensure processes and
  • Partnering with CBOs, local leaders, community colleges, and historically black colleges and universities on recruitment and retention.

The roundtable participants agreed that greater collaboration and alignment across levels of government and with local community-based and industry partners can help address many rural healthcare challenges.

“My administration will continue to focus on developing Wyoming-led solutions to some of our most significant challenges. We know that our state’s future depends on having reliable, affordable healthcare options for our residents.”

Governor Mark Gordon


The two roundtables revealed how interrelated economic development and healthcare are in rural communities. Healthcare and economic development are both essential aspects of individual and community wellbeing, and these policy areas represent key drivers of equity and are at the center of many of the policies explored through the Toward Better Rural Futures project. The NGA Center is grateful to the Robert Wood Johnson Foundation for funding these roundtables to foster such important conversations.


Rural Equity

Rural Economic Development

Rural Health

This article was written by NGA staff Anna Heard and Sally Rood. For more information on Governors’ rural economic development and healthcare efforts please contact