North Carolina's Next Chapter

North Carolina has surpassed 11 million residents and added more than 165,000 people in a single year — making it one of the fastest-growing states in the country. That growth is real, and it reflects genuine strengths: a diversified economy, world-class universities, and a quality of life that continues to attract families and businesses from across the country. But growth without strategy doesn’t become prosperity. It becomes gridlock, unaffordable housing, and a widening gap between the communities that are booming and the ones being left behind.

Key Findings

North Carolina’s growth is accelerating — and it’s concentrated. The state is on pace to become the seventh most populous in the nation by the early 2030s. Wake and Mecklenburg counties each added more than 20,000 residents in a single year. That concentration puts pressure on infrastructure, housing, and public services in the metros while rural communities — particularly in the northeast — continue to lose population and tax base.

Housing costs are outrunning incomes. Median home prices have risen 58 percent since 2017, while incomes have grown only 38 percent. The state faces a shortfall of 764,000 homes through 2029. More than one million North Carolinians are already cost-burdened, spending more than 30 percent of their income on housing. Without deliberate policy intervention, the workers who staff hospitals, schools, and local businesses will increasingly be priced out of the communities they serve.

Transportation investment hasn’t kept pace with growth. As population concentrates in metro corridors, commute times lengthen and infrastructure ages. Rural communities face a different problem: limited connectivity — both road and broadband — that cuts them off from economic opportunity and makes it harder to retain population or attract employers.

Healthcare access varies dramatically by ZIP code. Urban centers have expanded capacity, but large swaths of rural North Carolina face physician shortages, limited mental health services, and hospital systems under financial strain. Residents in less-served communities have shorter life expectancies and higher rates of preventable illness — a gap that undermines both quality of life and economic productivity statewide.

The urban-rural divide is widening, and it requires a statewide response. The communities losing population are not failing — they are under-resourced. Strategic investment in rural infrastructure, healthcare, and economic development is not charity; it is the precondition for the state’s continued growth story to be a genuinely shared one.

What North Carolina Should Do

• Expand housing supply through zoning reform, infrastructure investment, and incentives for mixed-income development
• Accelerate broadband deployment to underserved rural communities as foundational economic infrastructure
• Increase investment in rural healthcare access, including primary care, mental health, and hospital sustainability
• Build a long-range transportation plan that connects rural communities to economic corridors
• Adopt a statewide growth strategy that directs resources to communities and regions, not just to markets that are already growing