Our rural crisis

Students of North Carolina history recall that ours has been a saga of migration. Shortly after the early colonists settled along the coast there was a movement westward. Only a handful of towns had a population of more than 1,000. With the advent of the railroad enabling better transportation hundreds of factories sprung up, located mostly in the piedmont. More people exited the farm for a job in a textile, furniture or tobacco factory.

For almost two hundred years the political power in North Carolina resided east of I-95, controlled by Democrats. As large numbers of people moved west electoral districts were rebalanced by population, resulting in the east having fewer numbers of rural legislators and Governors who didn’t come from the east. The east declined in political influence. And rural counties became run by Republicans.

Today you can drive through many once-thriving towns in rural North Carolina and view main streets, where formerly thriving businesses are now vacant. A large number of these towns are dying or dead.

We’ve known for 50 years rural North Carolina needed help. Periodically discussions began, then waned. Solutions require money, leadership and time. And always some other issue emerges to divert our attention. We go for long periods when we hear little about rural problems, but with each year the problems become more urgent.

So here we are in 2025 with a long-neglected rural crisis. Of our 100 counties, 80 are designated as rural. 51 of these counties lost population, according to the 2020 census. 80 percent of our counties contain only 36 percent of our 11.05 million residents. We have the largest rural population of any state except Texas.

There are few job opportunities; jobs are generally lower paying, however employers in those counties complain they can’t find qualified applicants. Younger people are leaving. There’s no jobs for them. 22 percent of those remaining are over 65 and the population is becoming more Hispanic and Black. Unemployment rates and poverty are higher than the state average.

70 counties are designated as “medical deserts.” 3 of them have no physician, 5 have no dentist and 20 have no pediatrician. There have been 11 rural hospitals closed since 2005 and another 9 are barely hanging on. More than 20 percent of rural residents have no health insurance; a number that might have declined some because of Medicaid expansion. Drug problems are more prevalent and rural counties have a higher percentage of reported drug overdoses. The top 5 counties in North Carolina with gun-related homicides are rural.

1.5 million in rural North Carolina live in designated “food deserts,” with limited access to fresh vegetables. Affordable housing is scarce. There are few civic amenities, schools have lower education outcomes, the counties suffer from poor leadership and resources are few. Utility services, like water and sewer treatment plants, were built in the 50s and 60s and many of them desperately need replacing or, at the least, major renovations. But the declining tax base won’t provide needed funds.  

So here is the question that screams out for answers: What is it going to take for our state to recognize the critical problems in our rural counties? Where is the commitment to make this a “code red” priority?

One organization dedicated to the betterment of rural North Carolina is the NC Rural Center, led by Patrick Woodie and a dedicated board. It has done some good things, but let’s be honest in acknowledging that without more government representation and commitments from leadership in our state they are unable to tackle and solve big problems.

Rural North Carolina needs leaders, champions who will make this a priority mission. State and local governments alone cannot and aren’t the be-all solution, but they have a vital interest in and valuable role. They can be the catalyst and banker for making things happen.

If we continue to allow rural North Carolina to decline, all of us will pay a price. The longer things continue, the more dependent our rural counties will become on aid from federal, state and other sources. More and more tax dollars will be required to meet the health, education, utilities and basic needs of rural residents. Not only is it a moral imperative for us to come to the aid of our people, but it could easily become a legal imperative, like the Leandro education decision,  with courts mandating we provide help.

Our state has demonstrated before that when we unite we can do big things. Presently we are uniting to help victims of Hurricane Helene, mostly in rural counties. We need also to unite to help our rural neighbors. Not only are these counties some of the most beautiful parts of North Carolina but they contain needed farmland, water sources and other natural resources.

Let us act before things get even worse.

 Tom Campbell is a Hall of Fame North Carolina broadcaster and columnist who has covered North Carolina public policy issues since 1965.  Contact him at tomcamp@carolinabroadcasting.com