Brown: As rural challenges grow old, new efforts are needed

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Harsh fluorescent lighting cannot fully illuminate the challenges facing rural communities. And yet, far too often, a dim and inoffensive hotel conference center becomes the only place where political leaders hear about rural issues.

Greater Minnesota leaders and journalists know far too well the milquetoast milieu of brainstorming sessions, vision boards and PowerPoint slides. I’ve been to more than my fair share. Heck, urban leaders have attended similar conferences. The whole enterprise is as stale as those cinnamon rolls that have been sitting out since before anyone can remember.

But rural problems are real, so real that personal stress, political outrage and worry for the future now define the rural experience. The solution cannot be merely cosmetic but rather must directly address the burning issues.

That’s the goal driving “America’s Rural Future,” a bipartisan initiative by the nonpartisan Brookings-AEI Commission on U.S. Rural Prosperity. On Monday, I spoke with the commission’s co-chairs, former Gov. Chris Sununu, a New Hampshire Republican, and former Democratic U.S. Sen. Heidi Heitkamp of North Dakota.

They’ve both been to the same kinds of meetings. Heitkamp recalls the century of rural-focused policy initiatives that nevertheless resulted in bigger farms and fewer active farmers along the road where she grew up outside Mantador, N.D.

Thus, Heitkamp, Sununu and their commissioners are hitting the road, starting with events in Wheatland, N.D. On Thursday, they travel to Mahnomen to visit the White Earth Reservation in north-central Minnesota. In both places, local people will do the talking.

The scale of the problems facing rural America is daunting. The Commission on U.S. Rural Prosperity is investigating five main areas.

The first is the rural economy and workforce. What began years ago as a loss of jobs has become something different: a lack of people to do the jobs.

“Workforce is everything,” said Sununu. “You can build all these amazing things and develop all the infrastructure, but it’s not just the housing, you need the actual people.”

Sununu lives in a village of 1,500. Like many who live in rural America, he worked in big cities before deciding to settle in a small town. This kind of movement, he said, is important to building rural places, but that it’s crucial to listen to what young adults want.

Available space makes rural areas ideal for the restoration of American manufacturing, but for the fact that there aren’t enough people to do the work. For rural areas to thrive, more Americans will need to reconsider where they live.

“We also have to create a resilient flexible workforce because the job of today may not be the job of 10 years from now,” said Heitkamp.

The second area of focus will be demographics and rural connectedness. The whole country is older than it used to be, but in rural places the problem is acute. If not addressed, more older people will need care and connection than there are younger people to provide it.

With health care, a looming disaster awaits rural America. Small-town clinics and hospitals were already struggling with uncompensated care and low federal reimbursement rates for Medicare and Medicaid. Rural patients are much more likely to be on these programs or some state equivalent.

But with the passage of the so-called Big Beautiful Bill earlier this year, Medicaid eligibility will be squeezed, cutting more low-income people off from care. The same bill included a $50 billion grant program for rural hospitals, but Sununu said that won’t solve the problem.

Heitkamp said in addition to funding, the problem is systemic inflexibility.

“People want to do what they’ve always done and they can’t do what they’ve always done,” said Heitkamp. “So, health care will have to do more reforms.”

Those reforms might include more telehealth and traveling care. Sununu said immigration reform could bring qualified health care workers seeking legal entry to the country to rural areas, too.

As someone who still doesn’t have a doctor after our last provider left our rural clinic system, I welcome this discussion. To reform the system, however, hospitals and clinics must first survive the next few years.

The commission will also be listening for ideas about natural resources and environmental issues, climate resilience, policies and governance that affect rural communities. These are huge areas of concern in Minnesota.