For many rural communities across the country, the crisis in healthcare manifests as a lack of specialized healthcare. American medical schools are taking note and working toward providing specialists trained in treating rural residents.
From Eastern Tennessee’s mountains to the Pacific Northwest and beyond, medical schools are moving their programs directly into the communities that need them the most.
While people living in rural communities make up about 20% of the American population, only 9% of physicians across the country practice there. Research has shown that rural areas already have more residents 65 and older (19%) than urban areas (15%), and that share is growing.
Researchers expect the percentage of older people in rural communities to grow by more than 40% by 2034, making the disparities in care a larger concern. In many cases, if a community has a primary care physician, it may still lack a cardiologist, a dentist, or a surgeon.
At East Tennessee State University, the Quillen College of Medicine in Johnson City, Tennessee, is already ranked by U.S. News & World Report as No. 2 medical school in the country for graduates serving underserved communities. To combat the specialist shortage, the school said it is expanding its class size and focusing on surgical practice and research tailored for rural settings.
Dr. Bill Block, dean of the Quillen College of Medicine and ETSU’s Vice President for Clinical Affairs, said the programs were designed with rural practitioners and patients in mind.
“Our surgical residency is designed specifically to prepare physicians for practice in rural and underserved communities, where access to subspecialists is often limited,” Block wrote in an email response to the Daily Yonder. “In urban settings, surgeons typically have immediate support from a range of specialty colleagues and large health systems. In rural areas, general surgeons must be prepared to manage a broader scope of cases independently.”
“At Quillen, residents receive comprehensive, hands-on training, including opportunities in rural communities within the U.S. and Zambia (through our global surgery program), to ensure they are confident managing complex and emergency cases without the depth of specialty coverage found in urban centers,” Block explained.
This year, to address the growing need for rural healthcare specialists, the medical school’s class size will expand from 78 students to 100. In addition to hands-on training, the students will learn skills specific to rural healthcare.
“Helping physicians to choose to practice in underserved areas is accomplished by providing training that allows a level of comfort with the challenges in these settings,” Block wrote.
“Excellent medical training coupled with students selected for their affinity for this mission allows graduates to be culturally aware of rural and underserved communities and the challenges likely encountered. Focusing on communication skills that enhance interaction with patients and others in the healthcare team enables our graduates to be leaders in these medical communities and contribute from their first day in practice.”
More than 70% of the school’s graduates go on to practice in medically underserved areas, he noted, with about 10% practicing in an area deemed “rural” by federal classifications.
Other schools around the country focus on producing rural healthcare specialists as well, including the University of Washington’s WWAMI Program, which serves residents in Washington, Wyoming, Alaska, Montana and Idaho.
Its “Targeted Rural Underserved Track” links medical students to specific rural communities during their four years of education. The University of New Mexico School of Medicine also is nationally recognized for its focus on community-based medicine, health equity and placing students in deep rural, tribal and border communities. And the University of Minnesota Medical School features the Rural Physician Associate Program, providing an intensive nine-month continuous rural clinical residency to third year medical students.
But more than just programs is needed, Block explained. Policies and federal legislation that help students pay for the education are needed as well.
“Focusing on pathway programs that encourage students from these communities increases the chance that they will return after graduation,” he wrote. ”When they return, assuring that adequate support from other providers, integrated health systems, adequate medical transportation, and comparable compensation allows them to stay and thrive in these practice settings.”
Getting that funding through Congress hasn’t been easy this decade.
In 2010, as part of the Affordable Care Act, Congress created the Health Professions Opportunity Grant (HPOG) program that provided education and training to low-income people looking to enter the healthcare field. The program was a career pathway for postsecondary education to prepare nontraditional students for employment in the healthcare field.
The program was reauthorized in 2015 and then expired in 2021. Supportive lawmakers report that in its 11-year existence, the HPOG program served more than 60,000 participants in 32 programs across 23 states.
In 2023, U.S. Representative Danny Davis, D-Illinois, introduced the Pathways and Health Careers Act that would have reauthorized the HPOG program and expanded the model to address medical workforce needs in rural areas, providing $425 million to make HPOG available across the country from 2024 through 2028. That legislation stalled and was reintroduced in the House in 2025. The current bill has also stalled and is currently in the House Finance Committee.
According to the Medicus Firm’s 2026 National Physician & Healthcare Provider Preference & Insights Survey, young people just don’t want to go to rural communities to practice.
The issue isn’t just about the number of physicians available, but also about where young physicians want to go, the survey found.
“A common assumption in physician recruiting is that early-career doctors may be especially open to opportunities in rural America because of loan repayment programs, broader scope of practice, or the chance to make an immediate impact on access to health and human services,” the survey’s authors wrote.
“Among physicians who say they would prefer a different community type, only 5.3% say they would prefer a small town or rural setting. Physician practice location preferences lean much more heavily toward suburban communities (41.4%) and major metropolitan areas (28.3%) … Among physicians under 40, zero percent indicate a preference for rural practice, while 12.5% of physicians age 60 and older express interest in rural settings. This generational gap is one of the most consequential physician recruitment challenges organizations face in 2026.”
Another concern is that the hospital that hires a young doctor may soon close. Since 2010, more than 150 rural hospitals have closed or been converted to operating models that no longer provide inpatient care, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina.
But training physicians to adapt to the uncertainty of the rural health landscape is part of what medical schools should do, Block argued.
“Challenges with rural facility viability definitely increase the level of uncertainty and decrease the number of opportunities available to graduates,” he wrote. “It is virtually impossible for a physician to move to a rural area and begin an independent practice due to the current overhead costs involved. Supporting these practices requires an ecosystem of healthcare providers and hospitals that allow for the complexity of care delivery expected across all areas of the country.”
Block noted that “Training physicians who are knowledgeable in navigating these challenges is the premise behind focusing on rural and underserved aspects of education at the medical school and residency levels.”
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