Doing more with less has limits: Why rural health leaders need investment now

Rural health nonprofits across the country are navigating a rapidly shifting landscape—one defined by funding instability, policy uncertainty, and persistent gaps in access to care. In a recent peer learning conversation with nonprofit leaders from Alaska, Louisiana, North Carolina, and Mississippi, one thing was clear: The challenges are growing, but so is the determination to meet them.

As one participant put it simply, “We just keep going forward because we know that people need care.”

‘The complex reality rural health nonprofits face’

Rural communities are often defined by geography, but the reality is much more layered. For Trey Adcock, executive director of the Center for Native Health, “rural” includes cultural context, isolation, and infrastructure gaps. “We are on a tribal reservation, which is about as rural as it gets…we’re in a food desert…somewhat isolated in parts,” he shared.

Claudia Haines, CEO of Kachemak Bay Family Planning Clinic in Alaska, described a different but equally complex reality: “Some of the communities that we serve are actually only accessible by boat or plane,” and even access to basic health care can require traveling long distances on limited roads.

Across regions, rural communities share challenges like distance from services and limited infrastructure—but also key assets like strong relationships that help people navigate both. As Denae Hebert, executive director of the Louisiana Rural Health Association, noted, rural communities are used to adapting. “Rural people are resilient,” she said. “If we can plan, we can figure it out and we can make it through.”

Funding instability and the limits of resilience

The problem is that planning is becoming increasingly difficult. While resource constraints are not new, leaders described a sharp increase in instability since early 2025 due to changes in federal policies. These shifts have meant funding cuts or unpredictable delays in critical funding.

“There’s just…chaos,” said Haines.” That is the primary driver of our instability.”

“We lost a lot of money really, really fast,” said Hebert. “We had to cut programming…there’s a lot of things that we just had to cut because we just don’t have the money.”

Even organizations less dependent on federal funding are feeling the pressure. Adcock noted increasing competition in philanthropy: “A lot of our money comes from foundations, and it’s just gotten insanely competitive…now we just get standard letters back.”

A major concern is that rural health nonprofits’ long-standing resilience is being misread by funders. As Hebert explained, “We’ve been able to do so much with so little for so long…[but] we’ve reached a point where there is no more room.”

Haines put it more bluntly: “We don’t necessarily need funding that’s tied to a new innovation…. We know what we’re doing, and we are underfunded.”

Partnerships, and storytelling for survival

To sustain their work, organizations are relying on partnerships and storytelling.

“We are deeply embedded in partnerships with more than 20 other organizations,” said Haines. “It’s part of what makes rural communities so resilient.”

Hebert described how those relationships are evolving into practical survival strategies: “We’ve been able to have very transparent, trust-based conversations with our partners…. How do we work together to make sure that we both can survive this?”

Even small opportunities for exposure matter. “I’ve learned a lot just on this call,” said Adcock. “It also raises the profile of our organization.”

At the same time, storytelling is emerging as a powerful tool for visibility and funding. Adcock noted that refining their message has been key: “It’s really just honing in on our message and our storytelling…and choosing funders that align with our values.”

Advocacy, systems change, and building what doesn’t exist

As federal funding shifts, policy advocacy has become an essential strategy.

Hebert reframed advocacy as “telling your story to decision makers…. They need to hear how the decisions they make impact you and your community.”

Getty Israel, founder and CEO of Sisters in Birth in Mississippi, described a very different reality. “Traditional funders don’t seem to understand that the nation’s protracted maternity crisis requires more than short-term funding for unsustainable programs. For instance, in Mississippi, the Kellogg Foundation has contributed an estimated $25 million to nonprofit agencies and universities; yet, our birth disparities rates continue to outpace the nation. Community programs generally operate outside of the conventional healthcare system. Therefore, if funders are really serious about reducing these horrific birth disparity numbers, they must invest in building an alternative, evidence-based healthcare system, namely, freestanding birth and wellness centers that are based on disease prevention, whole-person care, and led by midwives,” said Ms. Israel, who is fundraising to build the first center in Mississippi.

Moving forward together

Despite the challenges, connection and collaboration remain sources of strength for rural health nonprofits.

For many, simply being in conversation matters. As Haines reflected, “There might be one little nugget that I pull from this… it’s really nice to hear those stories and it feeds my ideas.”

Hebert added that these connections help counter isolation: “It’s really easy to feel isolated…. Any opportunity to talk to each other and feel connected is helpful.”

Ultimately, rural health leaders are doing more than adapting—they are redefining what it takes to sustain care in their communities. But their message is clear: Resilience alone is not enough. Long-term investment, stable funding, and systems that genuinely support rural communities are essential. Meanwhile, leaders remain committed to their mission. “We’re just going to keep providing care for as long as possible,” Haines said.

Photo credit: SDI Productions/Getty Images