About 60 million people, or about 20% of the U.S. population, live in a rural area, according to the U.S. Census Bureau.

Even though they represent a significant share of the population, research suggests that people who live in rural areas often face lower access to employer-sponsored benefits, such as health insurance or retirement plans, compared with those who live in urban or suburban areas.

If they do have access, many still face hurdles using those benefits because of where they live. Those challenges may include a shortage of in-network health care providers, access to broadband internet or wellness programs that don’t fit their needs.

“Investing in the health and well-being of rural workers is important for workforce recruitment and retention and for productivity and quality of life,” said Carrie Henning-Smith, PhD, who is co-director of the Rural Health Research Center at the University of Minnesota and a professor of health policy and management.

Research points to several areas where rural workers may face benefit access gaps.

Internet Access

• The U.S. Department of Agriculture reports that 22.3% of those who live in rural areas in the United States and 27.7% of those on Tribal lands lack coverage of high-speed broadband internet services, defined as fixed service with speeds of at least 25 Mbps download and 3 Mbps upload. Lack of access could affect workers’ ability to take advantage of virtual benefit options.

Retirement Plans

• A 2025 report by the Economic Innovation Group found that half of rural adults working in the private sector didn’t have access to a retirement plan through their employer, compared with 41% in urban areas. In addition, 57% of rural workers lack savings plans with matching contributions from their employer, compared with 50% of urban workers.

Health Insurance

• According to a 2020 report from the Transamerica Center for Health Studies, rural residents are more likely than urban and suburban residents to be uninsured, with 19% lacking coverage. Rural residents are also less likely to receive health insurance benefits through an employer.
• Satisfaction with employer-based health insurance among rural workers was lower at 70%, compared with 84% among urban workers and 80% among suburban workers, the Transamerica report stated.
• According to the National Rural Health Association (NRHA), factors such as provider shortages and travel distance can increase the cost of health care for rural residents.

Henning-Smith further explained the health care divide between rural and urban residents. “Rural residents have more limited access to care than urban residents, which includes more limited facilities, more severe workforce shortages, transportation barriers and less specialty care,” she said in an emailed response to questions. “Rural residents are also more likely than urban residents to be uninsured and to rely on government insurers, including Medicaid. Because of that, many rural residents struggle to afford care or to find providers willing to take their insurance. (This is a particularly large issue for rural residents with Medicaid looking for dental care; finding a dentist in rural areas who accepts Medicaid is a challenge.)”

Ongoing closures of rural hospitals and other services have exacerbated the challenge of accessing care for rural residents, particularly those in the most remote areas, she said.

Another challenge for rural residents is that small businesses and self-employed rural residents are especially susceptible to increasing premiums and other changes in the payer landscape, Henning-Smith noted.

Wellness Programs

• Rural employees are less likely to be offered workplace wellness programs—30% said they are offered a program, compared with 52% of urban workers and 43% of suburban workers, the Transamerica report found.

Mental Health Services

• Rural residents often must travel long distances to receive mental health services and contend with provider shortages, the NRHA stated.

Leave Benefits

Rural residents have more underlying health problems than urban residents, and they often need to travel farther for care, Henning-Smith said. This means that, on average, rural employees have greater needs for health care and need to take more time to travel for that care, which can amount to more demand for time off or flexible work schedules.

Her research has shown that rural residents who are employed full-time have less paid sick leave than their urban counterparts. “This often means that people are put in difficult positions between getting the care they need and getting a paycheck. Yet, rural employers tend to be smaller than urban, which can cause challenges in providing paid leave and other benefits to their employees,” she noted.

What Can Employers and Plan Sponsors Do?

Employers may want to consider the following strategies to improve access to benefits for rural workers. The feasibility of some strategies may depend on the size of the employer.

• Incentivize proactive health initiatives. Giving workers time off to receive vaccinations, preventive screenings and biometric services can maintain good employee health and boost long-term productivity for employers, the Transamerica report notes.
  
• Offer health care on site. According to Transamerica, bringing health care professionals to the workplace can improve medication adherence and increase participation in immunizations, biometric screenings and physicals. Options could include mobile primary care, dental and vision clinics. Some providers can visit workplaces multiple times in a year. Employers also could host mobile mammography and preventive screening events, providing mammograms, skin cancer and cardiovascular screenings, suggested Alicia Clingan, CEBS, director of account management for ISM Insurance.
  
• Offer telehealth services with concierge scheduling. “Many employers offer telehealth, but rural employees often struggle finding local follow-up providers,” Clingan said. “The concierge component helps bridge the gap between virtual and local care.” The concierge model includes virtual care, care navigation, assistance with scheduling appointments, prescription coordination and specialist referrals. Limited access to high-speed internet is one important barrier to telehealth services. however.
  
• Provide virtual mental health services to help address provider shortages in rural areas. Services may include virtual therapy, on-demand coaching, mental health apps and text-based counseling, Clingan noted.
  
• Offer online or on-site financial services and resources. This could include a budgeting app or virtual financial planning sessions. Employers also could bring a financial planner on site to hold educational sessions helping workers who don’t have nearby access to financial planners.
  
• Tailor wellness programs to fit the needs of rural workers. This could include subsidizing a fitness app or providing stipends for home exercise equipment for workers who may not live close to gym.
  
• Participate in a state or city-facilitated retirement savings program. According to the Georgetown University Center for Retirement Initiatives, 22 states and three cities have enacted such programs. These programs allow workers whose employers do not offer a retirement plan to set aside money in retirement accounts through payroll deduction. A bill called the Retirement Savings for America Act (RSAA), which would create a federal retirement system with automatic enrollment and government contributions for low- and middle-income workers whose employers don’t offer retirement plans was reintroduced in Congress in 2025 but had not passed as of publication. Critics argue that the bill could encourage employers to cease offering retirement plans.
  
• Fund a lifestyle spending account (LSA). Depending on the plan design, employers could use the LSA to reimburse employees for the expense of internet services.
  
• Consider a cooperative model to provide benefits. Henning-Smith said small businesses and self-employed rural workers will likely continue to struggle to afford adequate benefits on their own and may want to consider cooperative models where they can band together with others in similar situations. “State and federal policy also has an important role to play in ensuring the well-being of individual workers and overall economic vitality of rural communities,” she noted.

Conclusion

Providing access to benefits is just one piece of the puzzle for employers and plan sponsors that want to support their rural employees and participants. Using strategies that consider health care provider shortages, travel distance and limited local resources can make benefits easier to use and may help workers stay healthier and more financially secure.

“Rural benefits aren’t necessarily richer benefits. They’re more accessible benefits,” Clingan explained. “The most innovative rural benefit strategies follow the same principle: Meet employees where they are rather than expecting them to come to the benefit.”