What Ails Rural North Carolina?

May 30, 2023


  • Rural North Carolina is in the middle of a severe, slow-motion crisis
  • Rural counties are receiving less, and worse, support from the state than ever
  • State lawmakers are actively worsening rural counties’ issues


For at least the last two decades, rural North Carolina has been undergoing a slow-motion crisis. A convergence of many factors, at multiple levels, is leading to compounding and interrelated issues that threaten severe, and possibly irreversible, hardship in rural counties. These include (but are not limited to) a shrinking population, widespread economic distress, a collapsing health system and deteriorating schools.

While some of the big, structural forces acting on rural North Carolina are beyond the ability of any policymaker to meaningfully influence, many others are completely controllable. Yet for over a decade, North Carolina’s lawmakers have not just ignored crises in our rural counties, but have actively made the problem worse. As they say, the best time to address North Carolina’s rural crisis was twenty years ago; the next best time is now. Yet all signs point to our state legislature obstinately keeping on the track it is on, and ignoring our rural friends and family.

Lawmakers’ track record of disaster

A widespread sentiment across rural North Carolina (and in rural America generally) is a perception of the unequal distribution of resources. There is a feeling that urban, metro counties are hoarding resources and that rural areas aren’t getting their fair share. Is that true?

Schools and taxes

Data first analyzed by EdNC shows that the public school system is the biggest single employer in 46 of North Carolina’s 100 counties, as of 2021. Because public schools in our state are mostly funded by the state, not local counties, this amounts to a large redistribution of resources from wealthier areas (which are mostly urban counties) to rural ones. In the 2020-2021 school year, funding for public schools in North Carolina was 66.7% from the state, 23.3% from counties, and 10% from the federal government.

Republican leadership in the legislature has fought tooth-and-nail against the Leandro Plan, a remedial strategy to re-invest resources in schools across the state. (See: What would the Leandro Plan mean for you?) Even after the North Carolina Supreme Court found that the Republican legislature was failing its constitutional obligation to provide a "sound and basic education" to every child in North Carolina, Republican leaders responded by ignoring the ruling, until a new Republican-majority court could block it. Rural schools thus missed out on a massive transfer of resources, largely funded by taxes on urban residents. (The Republican private school voucher scheme currently moving through the legislature would drain even more funds out of rural schools.)

The wealthiest Carolinian urbanites are paying a lot less in taxes overall than they used to. When Republican lawmakers flattened North Carolina's tax code and raised sales taxes in 2013, it massively benefitted wealthy people, who mostly live in cities. Urban counties today are keeping even more resources at home, and sending less to lower-income counties, than they were before.

What rural counties do receive more of: food stamps. A slightly higher proportion of rural counties' populations receive food assistance through the federally-funded, state-managed Food and Nutrition Services program (eg. SNAP, or food stamps) than do urban counties - though the rates are fairly similar overall.

NC lawmakers also continue to divert billions in federal assistance meant for basic assistance to low-income people, who are disproportionately rural, into programs that are clustered in urban counties.

The healthcare disaster

North Carolina is ranked #3 in the nation for the number of rural hospital closures: 11 have shuttered since 2005, including 6 since just 2014. 7 more are at "immediate" risk of closure. And it's not just hospitals - primary clinics are also going under. In January, ECU closed 5 more regional clinics down east that were losing millions each year. Today, wide swaths of rural North Carolina have effectively no access to health care at all. “From 7 in the evening to 7 in the morning, there is no rural health care in eastern North Carolina from Belhaven to Nags Head,” said the Mayor of Belhaven in Beaufort County.

The biggest reason? The stubborn refusal of the Republican-led legislature for over 12 years to expand Medicaid, until this spring's breakthrough in a deal championed by Governor Roy Cooper. Had the Republican legislature embraced Medicaid expansion years ago, many of our rural hospitals would still be serving residents.

The broadband boondoggle

Despite years of promises about broadband expansion, large swaths of rural North Carolina lack good broadband service - or any at all. The state's main way of addressing this issue has been perverse: the GREAT Grant program, established by the legislature, transfers millions in taxpayer dollars to big cable companies like AT&T and Spectrum to subsidize their customer acquisition. (See: "Rural broadband" is political theater)

Meanwhile, municipal broadband - a proven model that delivers lower-cost, locally-owned broadband internet services in dozens of states - remains banned in North Carolina, due to a 2011 law sponsored by the big cable lobby. Like in sessions past, this year's attempt in the legislature to rescind the ban was shut down without even a hearing. Thus, rural communities are denied the basic tools to bring the global economy to their own people.

Whistling past the graveyard

On virtually every front, North Carolina's lawmakers are failing its rural areas.

To be clear, there is very little that any state (or likely national) policymaker could do about "macro" forces affecting rural North Carolina: globalized trade, the internet economy, consumer preferences, global commodity prices or climate change. Yet this doesn't get them off the hook, either. Lawmakers are not just ignoring those parts of our state's rural crisis that they can control, but are actively contributing to the problems.

Yet the twist to this story is that it is the lawmakers that rural counties themselves send to Raleigh - overwhelmingly Republican - who are causing the damage. Instead of focusing on raising the standard of living in rural counties, lawmakers from those counties are instead pursuing partisan culture war battles like anti-trans legislation, abortion bans and making more school boards partisan.

While partisan gerrymandering heavily tilts the legislature overall in favor of Republicans, it is not why most rural counties in particular have sent Republican lawmakers to Raleigh. That is a more complex story of deepening political polarization. It may be that hot-button cultural issues are simply more important to rural voters than bread-and-butter questions of material wellbeing. Whatever the reason, the prognosis for rural North Carolina is grim without significant political change.

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