“I was Where I Needed to be”: The Rural Health Care Workforce Experience During the COVID-19 Pandemic

Abstract

More information is needed on how to recruit and retain rural health professionals, especially during times of crisis. In this article, we explore the experiences of rural health professionals during the COVID-19 pandemic. We conducted in-depth, semi-structured interviews with physicians, advanced practice providers, nurses, and allied health professionals in the state of Minnesota from 2023 to 2024 (n = 17) and used iterative thematic analysis to identify key themes. Two key themes emerged from our analysis as challenges during the COVID-19 pandemic: staffing shortages and the politicization of trust. Respondents also expressed satisfaction with rural life due to ease of social distancing and a strong sense of responsibility to their community. Despite the challenges presented by the COVID-19 pandemic for rural health professionals, respondents felt strongly about remaining in and serving their communities.

Keywords

rural workforce COVID-19 qualitative

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References

Allen

J. D.

Shrestha

Nguyen

K. H.

Stopka

T. J.

Cuevas

Corlin

(2022). Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults. SSM – Population Health, 20, 101278. https://doi.org/10.1016/j.ssmph.2022.101278

Campbell

J. L.

Quincy

Osserman

Pedersen

O. K.

(2013). Coding in-depth semistructured interviews: Problems of unitization and intercoder reliability and agreement. Sociological Methods & Research, 42(3), 294–320. https://doi.org/10.1177/0049124113500475

Cantor

Qureshi

Briscombe

Chapman

Whaley

C. M.

(2021). Association between COVID-19 relief funds and hospital characteristics in the U.S. JAMA Health Forum, 2(10), Article e213325. https://doi.org/10.1001/jamahealthforum.2021.3325

Carroll

Chang

J. Y.

(2025). Rural hospital closures led to increased prices at nearby “surviving” hospitals, 2012–22. Health Affairs, 44(5), 563–571. https://doi.org/10.1377/hlthaff.2024.00700

Cuadros

D. F.

Branscum

A. J.

Mukandavire

Miller

F. D.

MacKinnon

(2021). Dynamics of the COVID-19 epidemic in urban and rural areas in the United States. Annals of Epidemiology, 59, 16–20. https://doi.org/10.1016/j.annepidem.2021.04.007

Dudley

Couper

Kannangarage

N. W.

Naidoo

Ribas

C. R.

Koller

T. S.

Young

(2023). COVID-19 preparedness and response in rural and remote areas: A scoping review. PLOS Global Public Health, 3(11), Article e0002602. https://doi.org/10.1371/journal.pgph.0002602

Euhus

Williams

Burns

Rudowitz

(2025, June 4). Allocating CBO’s estimates of federal Medicaid spending reductions and enrollment loss across the states: House reconciliation bill. KFF. https://www.kff.org/medicaid/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-and-enrollment-loss-across-the-states/

Fritsma

Henning-Smith

Gauer

J. L.

Khan

Rosenberg

M. E.

Clark

Sopdie

Sechler

Sundberg

M. A.

Olson

A. P. J.

(2023). Factors associated with health care professionals’ choice to practice in rural Minnesota. JAMA Network Open, 6(5), Article e2310332. https://doi.org/10.1001/jamanetworkopen.2023.10332

Fusch

Ness

(2015). Are we there yet? Data saturation in qualitative research. The Qualitative Report, 20(9), 1408–1416. https://doi.org/10.46743/2160-3715/2015.2281

10.

Glaser

Strauss

(1967). Discovery of grounded theory: Strategies for qualitative research. Routledge. https://doi.org/10.4324/9780203793206

11.

Henning-Smith

Evenson

Corbett

Kozhimannil

K. B.

Moscovice

(2017). Rural transportation: Challenges and opportunities [Policy Brief]. Rural Health Research Center. https://rhrc.umn.edu/publication/rural-transportation-challenges-and-opportunities/

12.

Henning-Smith

Moscovice

Kozhimannil

(2019). Differences in social isolation and its relationship to health by rurality. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 35(4), 540–549. https://doi.org/10.1111/jrh.12344

13.

Hohman

(2025, July 8). What Trump’s “One Big Beautiful Bill” means for rural health clinics. National Association of Rural Health Clinics. https://www.narhc.org/News/31439/What%2DTrumps%2DOne%2DBig%2DBeautiful%2DBill%2DMeans%2Dfor%2DRural%2DHealth%2DClinics

14.

Johnston

K. J.

Wen

Joynt Maddox

K. E.

(2019). Lack of access to specialists associated with mortality and preventable hospitalizations of rural Medicare beneficiaries. Health Affairs, 38(12), 1993–2002. https://doi.org/10.1377/hlthaff.2019.00838

15.

Karim

S. A.

Carroll

N. W.

Song

P. H.

Atherly

(2025). Financial resilience of rural hospitals: Prepandemic vulnerabilities and Provider Relief Funds’ role during COVID-19. The Journal of Rural Health, 41(3), Article e70060. https://doi.org/10.1111/jrh.70060

16.

Kates

(2025, December 16). Recent changes in federal vaccine recommendations: What’s the impact on insurance coverage? KFF. https://www.kff.org/other-health/recent-changes-in-federal-vaccine-recommendations-whats-the-impact-on-insurance-coverage/

17.

Kiger

M. E.

Varpio

(2020). Thematic analysis of qualitative data: AMEE guide no. 131. Medical Teacher, 42(8), 846–854. https://doi.org/10.1080/0142159X.2020.1755030

18.

Kisa

(2024). A comprehensive analysis of COVID-19 misinformation, public health impacts, and communication strategies: Scoping review. Journal of Medical Internet Research, 26, Article e56931. https://doi.org/10.2196/56931

19.

Kozhimannil

K. B.

Interrante

J. D.

Carroll

Sheffield

E. C.

Fritz

A. H.

McGregor

A. J.

Handley

S. C.

(2025). Obstetric care access at rural and urban hospitals in the United States. JAMA, 333(2), 166–169. https://doi.org/10.1001/jama.2024.23010

20.

Levin

Bradshaw

. (2022). Determinants of COVID-19 skepticism and SARS-CoV-2 vaccine hesitancy: Findings from a national population survey of U.S. adults. BMC Public Health, 22, Article 1047. https://doi.org/10.1186/s12889-022-13477-2

21.

Lurie

Sharfstein

J. M.

(2023). State-to-state differences in US COVID-19 outcomes: Searching for explanations. The Lancet, 401(10385), 1314–1315. https://doi.org/10.1016/S0140-6736(23)00726-2

22.

MacDougall

Woldegerima

Henning-Smith

Fritsma

Olson

A. P. J.

(2025). Recruitment and retention of rural health professionals in Minnesota. Health Services Research, 60(3), Article e14453. https://doi.org/10.1111/1475-6773.14453

23.

Mohr

D. C.

Elnahal

Marks

M. L.

Derickson

Osatuke

(2025). Burnout trends among U.S health care workers. JAMA Network Open, 8(4), Article e255954. https://doi.org/10.1001/jamanetworkopen.2025.5954

24.

Morse

J. M.

(1989). Qualitative nursing research: A contemporary dialogue – Strategies for sampling (pp. 117–131). Sage. https://methods.sagepub.com/book/edvol/qualitative-nursing-research/chpt/strategies-sampling

25.

Mseke

E. P.

Jessup

Barnett

(2024). Impact of distance and/or travel time on healthcare service access in rural and remote areas: A scoping review. Journal of Transport & Health, 37, 101819. https://doi.org/10.1016/j.jth.2024.101819

26.

Nguyen

L. H.

Drew

D. A.

Graham

M. S.

Joshi

A. D.

Guo

C.-G.

Mehta

R. S.

Warner

E. T.

Sikavi

D. R.

C.-H.

Kwon

Song

Mucci

L. A.

Stampfer

M. J.

Willett

W. C.

Eliassen

A. H.

Hart

J. E.

Chavarro

J. E.

Rich-Edwards

J. W.

, . . . COronavirus Pandemic Epidemiology Consortium. (2020). Risk of COVID-19 among front-line health-care workers and the general community: A prospective cohort study. The Lancet. Public Health, 5(9), e475–e483. https://doi.org/10.1016/S2468-2667(20)30164-X

27.

Oster

N. V.

Patterson

D. G.

Skillman

S. M.

Frogner

B. K.

(2022). COVID-19 and the rural health workforce: The impact of federal pandemic funding to address workforce needs. https://familymedicine.uw.edu/chws/publications/covid-19-and-the-rural-health-workforce-the-impact-of-federal-pandemic-funding-to-address-workforce-needs/

28.

Paul

Arif

A. A.

Adeyemi

Ghosh

Han

(2020). Progression of COVID-19 from urban to rural areas in the United States: A spatiotemporal analysis of prevalence rates. The Journal of Rural Health, 36(4), 591–601. https://doi.org/10.1111/jrh.12486

29.

Pearman

Hughes

M. L.

Smith

E. L.

Neupert

S. D.

(2020). Mental health challenges of United States healthcare professionals during COVID-19. Frontiers in Psychology, 11, Article 2065. https://doi.org/10.3389/fpsyg.2020.02065

30.

Probst

Eberth

J. M.

Crouch

(2019). Structural urbanism contributes to poorer health outcomes for rural America. Health Affairs (Project Hope), 38(12), 1976–1984. https://doi.org/10.1377/hlthaff.2019.00914

31.

Rhubart

Kowalkowski

Yerger

(2023). Rural-urban disparities in self-reported physical/mental multimorbidity: A cross-sectional study of self-reported mental health and physical health among working age adults in the U.S. Journal of Multimorbidity and Comorbidity, 13, 26335565231218560. https://doi.org/10.1177/26335565231218560

32.

Saelee

(2022). Disparities in COVID-19 vaccination coverage between urban and rural counties – United States, December 14, 2020–January 31, 2022. MMWR. Morbidity and Mortality Weekly Report, 71(9), 335–340. https://doi.org/10.15585/mmwr.mm7109a2

33.

Sood

Entenman

Kitt-Lewis

Lennon

R. P.

Pinto

C. N.

Moss

J. L.

(2024). We are all in this together: Rurality, social cohesion, and COVID-19 prevention behaviors. The Journal of Rural Health, 40(1), 154–161. https://doi.org/10.1111/jrh.12781

34.

Soorapanth

Cheung

Zhang

Mokdad

A. H.

Mensah

G. A.

(2023). Rural–urban differences in vaccination and hesitancy rates and trust: U.S. COVID-19 trends and impact survey on a social media platform, May 2021–April 2022. American Journal of Public Health, 113(6), 680–688. https://doi.org/10.2105/AJPH.2023.307274

35.

Sun

Monnat

S. M.

(2022). Rural-urban and within-rural differences in COVID-19 vaccination rates. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 38(4), 916–922. https://doi.org/10.1111/jrh.12625

36.

Turrini

Volkov

Peters

Lew

N. D.

Buchmueller

(2024, October 31). Access to health care in rural America: Current trends and key challenges. Assistant Secretary for Planning and Evaluation. https://aspe.hhs.gov/sites/default/files/documents/6056484066506a8d4ba3dcd8d9322490/rural-health-rr-30-Oct-24.pdf

37.

Udayanga

(2025, September 16). Reflexive and iterative thematic analysis (RITA): A design-framework for qualitative research. Qualitative Research. Advance online publication. https://doi.org/10.1177/14687941251377282

38.

U.S. Department of Agriculture. (2025, May) Rural-urban commuting area codes. https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/documentation

39.

Weeks

W. B.

Chang

J. E.

Pagán

J. A.

Lumpkin

Michael

Salcido

Kim

Speyer

Aerts

Weinstein

J. N.

Lavista

J. M.

(2023). Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them. PLOS Global Public Health, 3(10), Article e0002420. https://doi.org/10.1371/journal.pgph.0002420

40.

Zahnd

W. E.

Silverman

A. F.

Self

Hung

Natafgi

Adams

S. A.

Merrell

M. A.

Owens

O. L.

Crouch

E. L.

Eberth

J. M.

(2023). The COVID-19 pandemic impact on independent and provider-based rural health clinics’ operations and cancer prevention and screening provision in the United States. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 39(4), 765–771. https://doi.org/10.1111/jrh.12753