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Navigating the Maze: How the Feds Define "Rural" for Healthcare Organizations

  • Writer: Charlotte Briggs
    Charlotte Briggs
  • Nov 7
  • 4 min read
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If you work for a clinic or hospital seeking federal grants, you know that the term "rural" can be an essential criterion for eligibility. What’s less understood is that there isn't a single, universally accepted definition of “rural” across all government agencies.

For health centers, FQHCs, and hospitals looking for grant support, understanding which definition applies to a specific program is the first step to securing a sustainable future.

At THRIVE, we specialize in guiding healthcare organizations through these complex regulatory landscapes. Here is a breakdown of how the federal government determines "rural" status and how you can check your eligibility for targeted programs.


The US Government Doesn't Use Just One "Rural" Definition


Different federal agencies and programs apply different criteria, creating a patchwork of definitions. Generally, these criteria blend data points about population size, density, and proximity to major urban hubs. The most common sources of definitions include:


  • U.S. Census Bureau: A basic definition used across many agencies, differentiating between "urban areas" and everything else. Areas not classified as urban are considered rural.

  • Office of Management and Budget (OMB): Defines US counties as either metropolitan and nonmetropolitan statistical areas, with the latter generally meaning what most people consider to be "rural" counties.

  • Federal Office of Rural Health Policy (FORHP): This is perhaps the most critical definition for federal health grants. FORHP uses a blended approach, incorporating the OMB definitions but also allowing specific sub-county areas (census tracts) within large metropolitan counties to qualify if they meet certain criteria like low population density or specific commuting patterns.


Key Criteria Used to Determine "Rural" Status


For specific healthcare programs, the eligibility hinges on detailed geographic codes and data sets:


1. Geographic Location (County & Census Tracts)


Your physical location is mapped against federal data sets. Programs often use tools that analyze your exact address or ZIP code to verify eligibility.


2. Rural-Urban Commuting Area (RUCA) Codes


Many programs rely heavily on RUCA codes. These codes categorize areas based on population density, urbanization, and daily commuting patterns. For the purpose of grant  program eligibility, a specific range of codes (typically 4-10) is often required for  a “rural” or “remote” area designation.


3. Program-Specific Requirements


The specifics matter. A hospital pursuing a Critical Access Hospital (CAH) designation has different requirements from a clinic applying for a USDA Rural Development loan.


  • Rural Health Clinics (RHCs): Must be located in a non-urbanized area and generally within a federally designated Medically Underserved Area (MUA) or Health Professional Shortage Area (HPSA).

  • Small Rural Hospitals: Many grant programs specify a maximum number of beds (e.g., 49 or fewer).


Check Your Status: Essential Tools


Navigating these definitions alone can be daunting. Fortunately, several web-based tools are available to help determine if a healthcare organization qualifies as "rural" based on specific federal definitions. These tools can be helpful for identifying eligibility for targeted grants, special payment designations, and other support programs. 


The primary resources can be found on government websites and the Rural Health Information Hub (RHIhub): 


Key Tools for Determining Rural Status

Tool Name 

Administered By

Purpose & Key Features

Am I Rural? Tool

Rural Health Information Hub (RHIhub)

A comprehensive tool that allows users to enter a specific address, city, or ZIP code to check its rural status against multiple federal definitions (e.g., Census Bureau, OMB, FORHP). This is an excellent starting point for a broad overview of potential eligibility across various programs.

Rural Health Grants Eligibility Analyzer

Health Resources and Services Administration (HRSA)

This is the official tool for determining geographic eligibility for HRSA's rural health grant programs. It uses the specific Federal Office of Rural Health Policy (FORHP) definition of rural, which includes nonmetropolitan counties and certain low-density census tracts within metropolitan areas.

Rurality Tier Search Tool

Universal Service Administrative Company (USAC) / FCC

Used to determine eligibility for the federal Healthcare Connect Fund (HCF) Program, which provides funding for broadband and telecommunications services to eligible healthcare providers.

USDA Property Eligibility Map

U.S. Department of Agriculture (USDA)

Primarily used for determining eligibility for USDA housing loans and community facility programs. It defines rural areas based on population limits (generally 20,000 or fewer, up to 35,000 in some cases) and is applicable for certain USDA Rural Development programs.


Where to Find the Tools




Important Considerations


  • No Single Definition: Remember that each federal program may use a slightly different definition. Always check the specific criteria for the grant or program you are applying for.

  • Program-Specific Requirements: These tools verify geographic eligibility, but other requirements (e.g., non-profit status, number of beds, target population) may also apply.

  • Data Updates: Rural definitions and maps are updated periodically based on new census data (e.g., from the 2020 Census), so it's best to use the most current tools available. 


THRIVE understands the needs of rural healthcare providers. Indeed, most of our consultants live and work in small towns or rural communities. If you need help pursuing funding as a rural healthcare organization, or wonder if your organization qualifies as “rural”, we hope you’ll contact us for a free introductory consultation. 

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