By Sally C. Pipes | February 4, 2026

Rural America is running out of doctors. According to a recent report from the Commonwealth Fund, 43 million Americans now live in rural communities facing a shortage of primary care providers.

This shortage isn’t new. It’s been reality for rural America for decades. And it helps explain why patients there experience higher rates of chronic illness -- and die sooner -- than their urban counterparts. 

At first glance, the problem seems simple -- too few doctors and nurses. But if that’s the case, why have so many states adopted regulations that restrict the supply of care? 

Our leaders need to scrap those regulations -- and simultaneously invest in efforts to train more healthcare providers locally. 

Consider scope-of-practice laws, which limit what kinds of care nurse practitioners and physician assistants can deliver to patients -- and how they can do so. In states such as Texas, Oklahoma and California, nurse practitioners must work under the supervision of another healthcare provider, generally a physician, for their entire career.

Physician assistants must deal with similar restrictions. 

Many of these highly trained professionals could treat patients immediately in rural communities that desperately need them. Instead, they’re sidelined by regulations that make it illegal for them to use the full extent of their education.

Rolling back these rules would quickly expand access to care.

“Certificate of need” laws are another barrier. These rules force would-be providers to convince state officials that a community “needs” a new clinic or facility before one can open. 

They also offer incumbent providers the chance to lobby against the entry of competitors. What incumbent wouldn’t want the government to outlaw its competition? That’s exactly what certificate-of-need laws can enable -- to the detriment of patients.

In any other part of the economy, high prices and long waits are signals for entrepreneurs to enter the market. In health care, CON laws replace market signals with bureaucratic permission slips.

Eliminating these laws would make it far easier for doctors and other clinicians to practice in underserved parts of the country.

Of course, paring back rules and regulations can only do so much. Rural America also needs a more robust pipeline of physicians. Fortunately, there’s evidence that doctors trained in rural settings often choose to stay. A recent study in the Journal of Graduate Medical Education found that residents who complete at least half their training in rural communities are five times more likely to end up practicing there.

Philanthropy could help build that pipeline of rural medical talent. Americans donated just under $600 billion to charity in 2024. Steering even a small portion of that sum to things like rural residency programs could begin to narrow the rural physician gap -- and eventually deliver huge returns for public health.

Rural America is in need of intensive care. Market forces can address that need -- if we let them.