The decline of rural America is being complacently accepted as a reasonable price to pay for the renewed dynamism of coastal cities. It’s time that philanthropy takes note.
Over the past year, right-wing media sources revealed that a number of the nation’s largest foundations, including the W. K. Kellogg Foundation and the Ford Foundation, were giving millions to nonprofit organizations associated with the anti-Trump “resistance,” including groups like the Center for Community Change, which gins up protests for progressive causes.
That wasn’t too surprising. Nor was it surprising when left-wing sources lamented that America’s big foundations weren’t deploying enough resources toward contesting the Trump administration and what it purportedly represents.
But what may be surprising, to those who do not follow the philanthropy world closely, is that the Kellogg and Ford foundations have historically been perhaps the nation’s largest funders of rural groups and programs. Now, those foundations were being criticized for—or else called upon to increase—their funding of organizations whose priorities manifestly are at odds with those who voted Donald Trump into office.
And for whatever else one might say about him, there can be no doubt that Donald Trump is the country dweller’s president.
His victory would have been impossible without the overwhelming support he received from rural areas. Trump won 80 percent of the nation’s counties, representing 85 percent of the nation’s land mass. In the 2,232 counties that contain no cities, he won 60 percent of the vote to Hillary Clinton’s 34 percent. In the four previous presidential elections, the Republican candidate’s advantage in these areas came nowhere near this 26-point edge. Trump’s vote percentage in rural counties was 29 points higher than it was in urban ones—a gap that again far exceeds those seen for Republican nominees from 2000 through 2012.
We must keep this deep rural-urban political divide in mind as we delve into the question of how philanthropic institutions and major donors relate to rural life today.
The role of philanthropy in sustaining rural life has received considerable attention in recent years. Funders like Kellogg, Ford, and others have evinced no interest in promoting rural people’s cultural and social ideals. Quite the contrary. The economic and health difficulties faced by America’s rural residents are considerable, and to some extent the philanthropic establishment is helping to alleviate these difficulties.
But as the 2016 election makes clear, what country and small-town residents long for is someone who will package technocratic assistance with a vision that recognizes the legitimacy of their values and aspirations. Ironically, the only person to offer them such a package, of late, is a bombastic playboy billionaire not exactly known for his charitable inclinations.
Before we can consider the ways in which philanthropy can help rural communities, we need to introduce some pertinent facts, facts that go beyond, and may help us better understand, today’s electoral urban-rural divide.
Let’s start with health care, with special attention to the opioid crisis that has in recent years captured public attention. People living in rural counties are approximately twice as likely to overdose on prescription painkillers as those living in non-rural counties. Opioid prescription levels are also higher in rural than urban areas, in part because jobs there tend to be more physically demanding, in part because it is easier for unscrupulous doctors to get away with over-prescribing such medications, and in part because of other, practical reasons: for example, a dairy farmer may have no time to travel to a distant city for more invasive, but potentially fruitful, treatments for whatever is causing him pain, and so he and his doctor rely on opioids to keep him functional.
Likewise, effective treatment for opioid addiction is harder to come by in rural areas. While 19 percent of the American population lives in a rural district, only 10 percent of opioid treatment resources are available in these areas, and just 11 percent of rural patients seeking treatment for opioid addition receive the gold-standard Medication-Assisted Treatment. The rural treatment desert is one reason drug-related deaths (primarily driven by opioids) are 45 percent higher in rural than urban places.
The downstream effects of the rural opioid crisis are pervasive.
It is hard to attract new business to an area known for its addiction crisis. Population decreases as new residents become harder to attract, and as older ones become more inclined to get out. Families crumble. The strain put on government budgets and social services, from policing to caregiving to housing to schools to health care, can be crushing.
Opioid addiction isn’t the only health problem suffered disproportionately by rural livers. Rural residents have a higher rate of chronic disease than non-rural residents, and one-third of rural residents lose all their teeth by age 65. Not coincidentally, perhaps, 65 percent of areas with health-professional shortages are rural, and rural hospitals are closing at a faster rate than elsewhere. An estimated 2,000 rural communities have just one pharmacist, who also often doubles as the lone health-care provider.
The health-care challenges facing rural areas are inseparable from challenges related to the disproportionate presence of the elderly there.
About 10 million people 65 and older live in rural America. Opioid misuse among this population is reportedly growing, and there is concern that it will only get worse as the demographic with the worst opioid-addiction problem—45- to 55-year-olds—ages.
Many older people, especially grandparents, have been drawn into the opioid crisis by children whose addictions mean they cannot raise their own kids. Those who have escaped being touched by opioids often face other issues, like not being able to get around: 13 percent of rural seniors have no car, and 40 percent of all rural residents live in counties without public transportation.
The result is that the rural elderly can be especially socially isolated. Such isolation is connected with myriad negative health outcomes, including depression, stress, smoking, chronic disease, premature death, and cognitive decline.
The elderly are disproportionately represented in rural areas in part because of brain drain—the out-migration of the most talented youths, year after year, from rural to metro districts.
Sixty percent of Americans lived in rural areas in 1900; that number is now 19 percent. But far less than 19 percent of the most talented Americans live in rural places, thanks to the federally subsidized, ruthlessly efficient academic-economic meritocracy that virtually ensures no smart kid is left behind.
In 1940, the gap between rural and urban areas, with respect to the proportion of residents who possessed a bachelor’s degree or higher, was five percentage points. By 2000, it had become thirteen percentage points. It is certainly higher today.
A rarely acknowledged contributor to the rural brain-drain problem is student loan debt. Since salaries and wages in rural areas are almost always lower than in urban and suburban ones, many graduates cannot afford to return to, move to, or stay in rural districts. This means, in turn, that attracting new businesses to rural areas, or starting new businesses there, is more difficult than it is elsewhere. The talent base simply isn’t present. One is faced with a recruiting problem immediately.
It is all part of a vicious cycle. For one reason young people continually move away from rural areas is because the economy is worse in such places, and good jobs comparatively scarce. The recovery from the 2008–9 recession has been slower in rural counties than in metro ones. It would lag even more if not for the plentiful jobs provided by oil and gas extraction in 100 or so counties across the country, jobs that are generally temporary and do not necessarily enrich local communities except for a brief season.
Farms are of course concentrated in fewer hands than ever, despite the counter-trend of growth in small, organic farms which concentrate on selling to farmers’ markets and local restaurants. (Between 2008 and 2014, sales of produce from organic farms rose by 72 percent, but the larger story is told by the reduction in the number of American farms from 6.3 million in the 1930s to 2.2 million today.)
Thanks to the decline of locally owned banks, and the passage of legislation (e.g., Dodd-Frank) making it harder than ever for small business owners and entrepreneurs to get loans, it can be maddeningly difficult for Americans living in small towns and rural places to access investment and other forms of capital.
Between 2008 and 2017, large businesses saw a 35 percent increase in bank lending, while small businesses experienced a 15 percent decrease. New businesses accounted for 8 percent of all firms in 2016, down from 13 percent in 1980; and were it not for tech start-ups, the 2016 number would be significantly lower.
Predictably, then, rural Americans are economically poorer than their counterparts in basically every demographic: seniors, children, households, minorities, etc.
Although the poverty rate in rural counties, overall, is slightly lower than in other counties, one in five rural children nevertheless lives in poverty. One in three blacks in rural areas lives in poverty. Eighty-five percent of counties deemed by the U.S. Department of Agriculture as “persistently poor” over the last three decades are rural. About 50 percent of rural households headed by a single mother are below the poverty line.
Single motherhood—that’s a relatively new rural phenomenon. Rural America was once a place characterized by intact families, low divorce rates, and high church attendance. All that has changed.
In 2011, for the first time, rural Americans became just as likely to be divorced as their suburban and urban counterparts. One-quarter of rural children do not live in a household headed by a married couple, a rate (23.7 percent) that is still lower than that of non-rural children (32.6 percent) but is rapidly rising.
Rural residents still score more highly on “religiosity” ratings than do urban dwellers, but as researchers like Brad Wilcox have shown, church attendance among whites with moderate levels of education appears to be in steep decline. And whites with moderate levels of education, as opposed to college-educated whites, are disproportionately present in rural America.
The responses to the diminishment and deterioration of rural life have been instructive. It is not unusual for the decline of rural America to be complacently accepted as a reasonable price to pay for the renewed dynamism of coastal cities, as in Richard Florida’s breathless celebration of the new urban “creative class.”
Urbanite liberals, of course, commonly speak about rural America with “irreverent humor and contempt,” as Lauren Kaori Gurley recently admitted in In These Times. In March 2017, Kevin Baker, writing in the New Republic, called for the abandonment of rural Americans via a “Bluexit.” “We’ll turn Blue America into a world-class incubator for progressive programs and policies, a laboratory for a guaranteed income and a high-speed public rail system and free public universities,” crows Baker. “We’ll focus on getting our own house in order, while yours falls into disrepair and ruin.”
Even conservatives have contributed to the narrative that today’s struggling country and small-town folk are essentially losers who deserve their fate. Kevin Williamson’s January 2014 article for National Review, titled “The White Ghetto,” made this argument in the most uncompromising terms possible. “The truth about [the] dysfunctional, downscale communities” found in rural America today, Williamson writes, “is that they deserve to die.”
Economically, they are negative assets. Morally, they are indefensible. Forget all your cheap theatrical Bruce Springsteen crap. Forget your sanctimony about struggling Rust Belt factory towns and your conspiracy theories about the wily Orientals stealing our jobs. Forget your goddamned gypsum, and, if he has a problem with that, forget Ed Burke, too. The white American underclass is in thrall to a vicious, selfish culture whose main products are misery and used heroin needles. Donald Trump’s speeches make them feel good. So does OxyContin. What they need isn’t analgesics, literal or political. They need real opportunity, which means that they need real change, which means that they need U-Haul.
Williamson simply dared to say what many coastal conservatives manifestly believe. Add it all up, and rural America isn’t left with many real champions.
Next week, I will consider what is being done by the philanthropic establishment in response to this state of affairs.
 Ninety-five percent of the American land mass is regarded as rural. Needless to say, within this vast area there are different patterns of rural life, and in many rural places multiple kinds of “rural” coexist with one another. One classification scheme in use within the philanthropy establishment identifies four distinct rural categories:
- Rural areas within ninety minutes of significant urban areas.
- High amenity rural areas known for their scenic beauty, and thus home to significant wealth. Think of northern California, areas of Montana and Colorado, etc.
- Sparsely populated rural areas, characterized by low population density and substantial isolation; such areas are particularly common in the West; and
- High poverty rural areas, such as we find throughout the south, Appalachia, and within Native American reservations.
 See Patrick J. Carr and Maria J. Kefalas, Hollowing Out the Middle: The Rural Brain Drain and What It Means for America (Boston: Beacon Press, 2009).
 My profound thanks to Philanthropy Daily editor Macarena Olsen for her research assistance in the preparation of this essay.