The Centers for Medicare and Medicaid Services have outlined an ambitious vision for transforming rural healthcare through the $50 billion Rural Health Transformation (RHT) Program. Coming at a time when more than 300 rural hospitals are at risk of closure1 and healthcare worker shortages have reached crisis levels, their five strategic pillars – sustainable alliances, technological innovation, lifestyle initiatives, workforce development, and innovative care models – represent the comprehensive approach rural America desperately needs.
But workforce isn’t just one pillar among five. It’s the foundation that makes everything else possible. And the current approach to healthcare workforce development is failing. In nursing alone, the country is facing a shortfall of nearly 300,000 registered nurses, and the shortages in rural communities will be more than triple what they are in metro areas by 2027.2 The time is right to think differently.
The administration’s emphasis on structural fixes is sound. While there are many approaches to addressing healthcare workforce shortages, one of the most impactful changes we can make is rethinking where we train healthcare professionals. It’s known that students from rural communities often want to return to practice there.3 But training students in university towns or metro areas for extended periods of time lowers their likelihood of returning. It’s not an approach that will help us fill shortages.
When we develop healthcare professionals from within the communities they’ll serve, retention rates increase. These aren’t just job numbers – they represent nurses, doctors, and clinicians for communities in crisis, and create stronger connections and significantly better long-term outcomes for both providers and patients.
The online and flexible nursing programs we offer through our universities solve for this – even in communities where the nearest hospital is miles away, our students gain the skills they need to join the healthcare workforce. Our experience with these programs demonstrates an alternative to conventional approaches to rural healthcare workforce development.
Consider Dr. Terrie Becker in Blythe, California, a town of 18,000 in the Sonoran Desert. Blythe had struggled with chronic nursing shortages for years, but as a three-time Chamberlain University graduate from a small town herself, Dr. Becker saw that the route to real, lasting change would be to establish the area’s first nursing program within 100 miles. Nearly a third of the graduates of the program stayed to work in Blythe’s only hospital – ending years of expensive travel nurse dependence.
Dr. Becker’s success illustrates what sustainable workforce development looks like: healthcare professionals committed to rural communities, trained through flexible programs that let them stay embedded locally while gaining advanced skills and then applying them where they practice.
The RHT correctly identifies workforce recruitment and retention as a critical challenge and suggests innovative solutions like expanded pharmacist roles and streamlined licensing. These are important steps, but state leaders now need to address the root cause of the rural healthcare challenge: traditional healthcare education often requires students to sever their connections to rural communities.
Online and hybrid programs allow students to pursue advanced degrees while remaining in their communities, completing clinical rotations at local facilities, and maintaining the connections that will keep them there after graduation. With half of the RHT funding allocated based on states’ potential for impact, governors need to demonstrate not just what they’ll build, but who will staff it – now and in the decade ahead.
The most audacious proposal states can make is this: we will grow our rural healthcare workforce from within our rural communities themselves. We will educate nurses in the hospitals where they’ll work, train mental health counselors in the communities they understand, and prepare physicians in environments that mirror where they’ll practice. Creating these favorable conditions for healthcare professionals to remain in their communities and keep hospitals adequately staffed is critical: studies have shown that simply maintaining a 4:1 patient-to-nurse ratio can result in thousands of lives and millions of dollars saved.4
States have a choice: repeat failed workforce strategies and hope this time will be different, or partner with institutions that have demonstrated success in community-based healthcare education at scale and over time. The governors who secure competitive funding will be those who demonstrate workforce solutions that make the other four RHT pillars achievable. HHS and CMS have created a historic opportunity. The question is which states will have the workforce foundation to seize it.
Steve Beard is the chairman and CEO of Adtalem Global Education, which serves over 90,000 students annually across five institutions, the majority of which are pursuing healthcare degrees.
1 Center for Healthcare Quality and Payment Reform.(2025) “Rural Hospitals at Risk of Closing” https://ruralhospitals.chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf
2 National Center for Health Workforce Analysis. (2024). Nurse Workforce Projections, 2022-2037.
3 Diemer, D. (2012). Factors That Influence Physician Assistant Program Graduates to Choose Rural Medicine Practice. The Journal of Physician Assistant Education, 23(1), 28–32. https://doi.org/10.1097/01367895-201223010-00005
4 Lasater KB, Aiken LH, Sloane DM, French R, Anusiewicz CV, Martin B, Reneau K, Alexander M, McHugh MD. Is Hospital Nurse Staffing Legislation in the Public’s Interest?: An Observational Study in New York State. Med Care. 2021 May 1;59(5):444-450. doi: 10.1097/MLR.0000000000001519. PMID: 33655903; PMCID: PMC8026733.
