The concept of rural incorporates rural residents, where residents face distinct health challenges due to economic conditions, cultural/behavioral factors, and health provider shortages that combine to impose striking disparities in health outcomes among rural populations versus an urban or metropolitan area(s).


Rural has been defined in many ways, most often in terms of non-urban status. Three of the most commonly used definitions are from the U.S. Bureau of the Census during Census 2000, the Office of Management and Budget (OMB) and the U.S. Department of Agriculture (USDA).

  1. 1. The Federal Office of Rural Health Policy (ORHP) defines rural as located outside a Metropolitan Statistical Area (MSA), or located in a rural census tract of a MSA as determined under the Goldsmith Modification or the Rural Urban Commuting Areas.

  2. 2. The Bureau of the Census classifies "urban" as territory, population, and housing units located within an urbanized area (UA) or an urban cluster (UC), which has a population density of at least 1,000 people per square mile; and surrounding census blocks with an overall density of at least 500 people per square mile.

  3. The Bureau of the Census classifies "rural" as all territory, population and housing units located outside of UAs and UCs.

  4. 3. The Office of Management and Budget defines a Metropolitan Statistical Area (MSA) as:

      • one city with a population of 50,000 or more, or
      • an urbanized area (as defined by the Bureau of the Census) with a population of at least 50,000 and a total MSA population of at least 100,000 (75,000 in New England).

Each MSA must include the county in which the central city is located and additional contiguous counties (fringe counties), if they are economically and socially integrated with the central county. Any county not included in an MSA is considered non-metro or "rural."

  1. 4. The USDA Economic Research Service (ERS) uses rural-urban continuum codes, to distinguish metro counties by size and non-metro counties by their degree of urbanization or proximity to metro areas. USDA defines codes zero to 3 as metro and 4 to 9 as non-metro (e.g., 4 = Urban population of 20,000 or more, adjacent to a metro area; a code of 9 = completely rural or urban population of fewer than 2,500, not adjacent to a metro area).

Health Professional Shortage Areas

HPSAs may be designated as having a shortage of primary medical care, dental or mental health providers. They may be urban or rural areas, population groups or medical or other public facilities.


Medically Underserved Areas and Populations

Medically Underserved Areas (MUAs) may be a whole county or a group of contiguous counties, a group of county or civil divisions or a group of urban census tracts in which residents have a shortage of personal health services.
Medically Underserved Populations (MUPs) may include groups of persons who face economic, cultural or linguistic barriers to health care.