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Covid in Rural America: 2020

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January 12, 2021

The US had 46 million rural or nonmetro residents in July 2019, unchanged from 2010. All US population growth between 2010 and 2019 was in urban or metro areas. The 16 percent rural poverty rate in 2018 was higher than the 13 percent urban poverty rate.

Almost two-thirds of the 3,143 US counties are nonmetro or rural, and most are in the Midwest and southeast.

Most of the 3,143 US counties are nonmetro (grey), and most are in the Midwest and southeast

USDA classifies counties along a continuum based on their population and proximity to urban areas. The nonmetro counties with fewer than 2,500 residents and not adjacent to urban areas (red) are mostly in the Midwest, while the urban counties with over a million residents (green) are in areas with major cities.

Rural counties that are not near urban areas are mostly in the Midwest

Covid. Covid was an urban issue during the spring and summer of 2020, but in Fall 2020 the rate of new covid cases was higher in rural than in urban areas.

The covid infection rate was higher in in rural than urban areas in fall 2020

The death rate from covid was also higher in rural than in urban areas, reflecting the older and thus more vulnerable population of many rural counties. A higher share of rural residents have underlying health conditions that make them more vulnerable to complications from covid, many lack health insurance, and most are further from hospitals with ICUs than urban residents.

Rural people are more vulnerable to covid and its complications

Rural people are more vulnerable to covid and its complications
Vulnerability Source Nonmetro Metro
Underlying health problems (ages 20 to 84) 23.7% 3.0%
Old adult population scale 15.9% 4.0%
Lacking health insurance (ages 25-64) 20.2% 10.5%
Distance to hospital with intensive care unit (ICU) 11.3% 0.3%


Before the covid pandemic, US unemployment rates were trending downward, below four percent in 2019 and early 2020. The US unemployment rate spiked to almost 15 percent in April 2020, and fell to less than seven percent by the end of 2020 The rural unemployment rate was below the urban rate in 2020.

Rural unemployment rates have been higher than urban rates, but fell below urban rates in 2020

Covid was especially prevalent in the 56 meatpacking counties, defined as counties that have 20 percent or more of workers employed in meatpacking; 49 of these counties are considered nonmetro. Employment in US meatpacking is about 500,000, and meatpacking is concentrated in a handful of counties. By comparison, only 12 counties have 20 percent of more of their employment in autos and auto parts.

Covid cases spiked in meatpacking counties in April-May 2020 before falling toward the same rate as in other rural counties. In fall 2020, covid rates rose in both meatpacking and non-meatpacking rural counties.

Covid cases spiked in meatpacking counties (blue) in April-May 2020

As with farm work, meatpacking work does not require formal education or English. Sinclair Lewis’s account of wages and working conditions in The Jungle in 1906 led to federal laws aimed at keeping diseased animals out of the meat supply. Today, many meatpacking workers are immigrants with few other job options who are employed in large plants often located in rural areas.

Stull emphasizes that meatpacking is more often a job than a career, recounting the story of a kill floor worker who began as #500 on the seniority list and was #75 when he quit eight years later. The injury and illness rate in meatpacking, although dropping in recent years, is three times that of other manufacturing.


Cromartie, John, Elizabeth Dobis, Thomas Krumel, David McGranahan, and John Pender. 2020. Rural America at a Glance. USDA EIB 221.

Rural Economy and Population.

Stull, Donald. 2020. Making Meat in the Time of COVID-19. Anthropology Now.

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