We define rural areas so that organizations can apply for rural health grants. Please read each funding opportunity for the specific eligibility for each grant.
Use the Rural Health Grants Eligibility Analyzer to see if your location is in a rural area. You can also use the Analyzer to see if your service areas are rural using our definition.
This webpage explains the data sources and methods that we use to define rural areas. The Rural Health Grants Eligibility Analyzer uses these data.
Our rural definition
We define the following areas as rural:
- Non-metropolitan counties
- Outlying metropolitan counties with no population from an urban area of 50,000 or more people
- Census tracts with RUCA codes 4-10 in metropolitan counties
- Census tracts of at least 400 square miles in area with population density of 35 or fewer people per square mile with RUCA codes 2-3 in metropolitan counties
- Census tracts with RRS 5 and RUCA codes 2-3 that are at least 20 square miles in area in metropolitan counties
Based on 2020 Census data, FORHP considers 20.3% of the population (62.8 million people) and 87.4% of the land area of the country to be rural.
See the sections below for an explanation of these terms and where they come from.
Where do rural definitions come from?
The United States Census Bureau (Census), the Office of Management and Budget (OMB), and the United States Department of Agriculture Economic Research Service (ERS) are agencies of the Federal government that describe geographic areas for various purposes. We at the Federal Office of Rural Health Policy (FORHP) use their delineations and data to form our own rural definition. These data sources include non-metropolitan counties (PDF - 1 MB) identified by OMB and two measures developed by ERS, the Rural-Urban Commuting Area (RUCA) codes and the Road Ruggedness Scale (RRS).
How does the Census define rural?
The Census does not define “rural.” They classify what is “urban” and consider “rural” to include all people, housing, and territory outside of urban areas. Any area that is not urban is rural.
The Census defines urban areas as having at least:
- 5,000 people or
- 2,000 housing units
After the 2020 Census, they classified 20% of the population (66.3 million people) and 97% of the land area as rural.
How does OMB define rural?
OMB also does not define “rural.” OMB decides which counties are metropolitan (metro), micropolitan (micro), or neither. While OMB does not characterize counties as rural or urban, the FORHP definition of rural includes all non-metro counties as rural.
| Area or County | Rural or Not Rural |
|---|---|
| Metro area (urban core of 50,000 or more people) | Not rural |
| Micro area (urban core of 10,000 – 49,999 people) | Rural |
| Counties outside of Metro or Micro Areas | Rural |
After the 2020 Census, the non-metro counties contained 46.0 million people (about 13.7% of the population) and covered 71.6% of the land area of the country.
OMB periodically updates the lists of metro and micro counties. We have updated the FORHP definition of rural to use the county delineations that OMB issued in July 2023 in OMB Bulletin 23-01 (PDF - 1 MB).
Why does FORHP define rural differently from Census and OMB?
The Census and OMB delineations present challenges when we need to describe rurality for rural health purposes.
The Census counts a higher number of people in rural areas, while OMB finds a lower number residing in non-metro areas. At the same time, some areas considered non-metro under OMB’s delineation are not rural according to the Census while other areas considered metro by OMB are rural according to the Census.
- The Census classification of urban areas does not follow city or county boundaries. This can make it hard to determine if an area is urban or rural when using common geographic boundaries.
- The OMB delineation includes some large, unpopulated areas in metro counties.
Example: The Grand Canyon is in a metro county.
How does the FORHP definition address these issues?
We use Rural-Urban Commuting Area (RUCA) codes and Road Ruggedness Scale (RRS) codes. First, this allows us to assess rurality on a smaller, census-tract level. It also allows us to account for core characteristics of rurality such as low population density and geographic isolation in greater depth. The U.S. Department of Agriculture’s (USDA)’s Economic Research Service (ERS) creates these codes using Census data.
How many census tracts are there in the United States?
There are more than 70,000 tracts in the United States.
Do RUCA codes work for larger tracts?
In larger tracts, we do not use RUCA codes alone. The codes do not factor in distance to services and low numbers of people over large areas.
In metro counties we consider large area census tracts with RUCA codes 2 or 3 as rural. These tracts are at least 400 square miles in area with no more than 35 people per square mile.
What about rugged terrain?
Rugged terrain can make it difficult for people to get health care. In rugged terrain people often must travel over difficult, mountainous roads.
In metro counties we consider certain highly rugged census tracts as rural. These tracts are at least 20 square miles in area with RUCA codes 2 or 3 and RRS 5.
How can I find a complete list of rural areas?
Download our data files for lists of rural areas by county, census tract, and ZIP code.
How has the definition changed over time?
We monitor national research and analysis efforts related to defining rural areas. As new methods and data become available, FORHP may update the definition.
In recent years we expanded the definition of rural to include these two types of rural areas:
- FY22 – outlying metro counties with no population from an urban area of 50,000 or more people
- FY25 – certain census tracts with highly rugged roads in metro counties
For more detail on the addition of outlying metro counties, read the 2021 Federal Register Notice, Revised Geographic Eligibility for Federal Office of Rural Health Policy Grants.
For more detail on the addition of the Road Ruggedness Scale, read the 2024 Federal Register Notice, Inclusion of Terrain Factors in the Definition of Rural Area for Federal Office of Rural Health Policy Grants.
How do updates to the definition affect me?
Adding new components to the FORHP definition (such as road ruggedness) expands the number of rural health areas. However, regular updates to the underlying data (OMB, RRS, RUCA, Census) may add or remove rural areas.
Changes to the FORHP definition or underlying data may affect the ability of people in your geographic area to benefit from our rural health grants. The Rural Health Grants Eligibility Analyzer will show you all current rural health areas, including areas that are newly rural.
Counties that were fully rural in FY24 and have changed status in FY25 (PDF - 44 KB) will retain eligibility for FORHP funding in FY25. These counties may still include rural census tracts, but they are no longer fully rural due to the 2023 OMB updates adopted for FY25.