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Rural Folks Resist Vaccines, Overload Hospitals, Kill More Neighbors

Survival of the fittest?

One of the advantages rural life offers that can coax urban folks to give up almost half of their pay and sacrifice other advantages of city life is the notion of rural neighborliness. We rural folks like to portray ourselves as helpful communitarians, folks who know, talk with, and help our neighbors more often than those darned brusque, aloof city folk. That distinction of rural connection from urban isolation does not leap clearly from research… and I will confess my personal faith in my rural neighbors to look out for my well-being and the well-being of others has been shaken hard by South Dakota’s shrugging-to-reckless response to the coronavirus pandemic.

South Dakota’s lazy and wrongly politicized approach to vaccines, masks, and other pandemic-prevention measures typifies rural attitudes nationwide. Those rural attitudes are producing a predictable result—higher death rates from coronavirus:

While the initial surge of covid-19 deaths skipped over much of rural America, where roughly 15% of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to data from the Rural Policy Research Institute.

Since the pandemic began, about 1 in 434 rural Americans have died of covid, compared with roughly 1 in 513 urban Americans, the institute’s data shows. And though vaccines have reduced overall covid death rates since the winter peak, rural mortality rates are now more than double urban rates — and accelerating quickly [Lauren Weber, “Covid Is Killing Rural Americans at Twice the Rate of Urbanites,” Kaiser Health News, 2021.09.30].

I care about you, neighbors. I don’t want you to die. Last spring, I was willing to give up a half hour of my time and get two shots to help reduce your chances of dying. But too many of you are refusing to make the same, simple, safe sacrifice, thus leaving my family’s chances and other rural family’s chances of getting sick and dying significantly higher than it has to be. And now we rural folks are seeing more of the people we care about die from coronavirus than we would if we lived in the big cities.

The problem isn’t just coronavirus. Among the things we sacrifice to live in nice, quiet rural America is easy access to health care:

Access to medical care has long bedeviled swaths of rural America — since 2005, 181 rural hospitals have closed. A 2020 KHN analysis found that more than half of U.S. counties, many of them largely rural, don’t have a hospital with intensive care unit beds.

Pre-pandemic, rural Americans had 20% higher overall death rates than those who live in urban areas, due to their lower rates of insurance, higher rates of poverty and more limited access to health care, according to 2019 data from the Centers for Disease Control and Prevention’s National Center for Health Statistics [Weber, 2021.09.30].

When lots of our rural neighbors refuse to get vaccinated and then predictably get covid and fill up hospital beds, they increase the chance that rural neighbors who suffer heart attacks or other serious illnesses won’t get the care they need to survive:

Additionally, the overload of covid patients in hospitals has undermined a basic tenet of rural health care infrastructure: the capability to transfer patients out of rural hospitals to higher levels of specialty care at regional or urban health centers.

“We literally have email Listservs of rural chief nursing officers or rural CEOs sending up an SOS to the group, saying, ‘We’ve called 60 or 70 hospitals and can’t get this heart attack or stroke patient or surgical patient out and they’re going to get septic and die if it goes on much longer,’” said John Henderson, president and CEO of the Texas Organization of Rural & Community Hospitals [Weber, 2021.09.30].

Things spiral downward from there: hospitals serving rural areas get overloaded with vaccine-preventable covid cases, health care staff get burned out and retire or leave for better pay and better working conditions in the city, the endemic shortage of health care workers in rural America gets worse, more rural hospitals close… and living in rural America requires more and more sacrifices, some of them mortal sacrifices.

Live fast, die sooner in South Dakota? I don’t think that slogan will help South Dakota or any other rural community recruit healthy workers and families who can sustain a thriving economy and culture.

We rural Americans aren’t living up to our professed values as well as our city cousins. And when we refuse to get our shots, we shoot ourselves in the foot.


  1. ArloBlundt 2021-10-01 19:02

    Well…rural nursing homes are also in crises. Staff is exhausted and the labor shortage is critical. Governor Noem has done absolutely NOTHING to address this crises. She seems very comfortable that South Dakota’s nursing homes receive the lowest state reimbursement of all Midwestern states. She has no interest in the welfare of the elderly….I have never heard her discuss quality of care issues in any public forum. This crises may as well be happening on the moon.

  2. Porter Lansing 2021-10-01 19:19


    What’s left over when the best and brightest have moved to cities for the last seventy five years?

    A depleted gene pool of ignorance.

  3. Bonnie B Fairbank 2021-10-01 19:24

    Coincidentally, CAH, I just forwarded you a nasty-gram I sent to the Fall River County Herald and Hot Springs Star on 7/14/21, expressing my fervent desire the participants in the upcoming Sturgis Rally all infect each other with COVID and take it home to their willfully ignorant families, friends, and contacts. I admitted I’ve been pitiless since I moved to South Dakota; frankly, I’ve never encountered so many purposely stupid people.

  4. Mark Anderson 2021-10-01 19:44

    Well Cory, it’s not just the rural folks, its the trumpians everywhere. We could all be out of this if people just got their shots. I’m sick of it. They can all just infect each other, bankrupt the country and fill all the hospitals and die. I don’t care anymore.

  5. sx123 2021-10-01 20:15

    Couple weeks ago I discussed with an older person in the area that she and her husband should get vaccinated. She said it’s just the flu and figured they were pretty immune. I said no it isn’t the flue. She said it was a hoax and conspiracy.

    Her husband got intubated week before last and died from covid a couple days later.

    I don’t know what to tell ya… My vaccinated 14 yr old daughter has more balls than some of these men around here.

  6. ArloBlundt 2021-10-01 20:26

    It’s not that the state is broke and can’t provide emergency funding to nursing homes to raise wages and recruit staff. We’re running a historic surplus that we are spending on Tourism promotion and rodeo arenas. The federal Covid money was for Covid impacted facilities like nursing homes but the Republicans have hoarded it while the elderly die. Its a windfall of death for the leadership of this state. The Governor’s and Legislature’s neglect is the direct cause of this crises. We need an explanation.

  7. mike from iowa 2021-10-01 20:31

    South Dakota’s main problem is piss poor government in all areas. Magats are killing people by the dozens because they don’t care about ordinary people. Noem Nothing is the absolute worst of the bunch.

  8. RS 2021-10-01 22:05

    Watching the daily covid sheet of cases or deaths of adult un-vaccinated South Dakotans, is like seeing the highway patrol pull over a guy that just passed you going 90 in a 55mph zone. Shaking your head ,trying not to smile.

  9. jerry 2021-10-01 23:06

    Viatical insurance on these folks. Why not make a killing on their killing themselves from the ignorance of 700,000 covid deaths and rising? Hang around the local coffee shop and you will find just the perfect starting point. Hint, get the conversation going by asking about Ivermectin for a friend.

  10. larry kurtz 2021-10-02 08:05

    Three hospitals in South Dakota operate as an oligopoly statewide and as monopolies in their own markets. Montana is pretty much the same: Benefis, Deaconess and the Billings Clinic operate as a virtual triopoly in that state, too. It’s disaster capitalism for oligarchs and religionists masquerading as health care. Senator Jon Tester (D-MT) has known about the monopolistic nature of rural hospitals for decades now red state Montana is seeing 1,200 people contracting the Trump Virus every day.

    After Amtrak’s Empire Builder derailed near Joplin, Montana many of the injured passengers were unable to find medical care because area hospitals are overwhelmed with unvaccinated Republicans. The Benefis Health System hospital in Great Falls is about 100 miles from Joplin.

  11. Cory Allen Heidelberger Post author | 2021-10-02 08:37

    Is “rural” America demonstrating that its values make it unfit to survive?

  12. larry kurtz 2021-10-02 09:09

    Rural America is increasingly divided by class and wealth.

    Now that a progressive has been confirmed as director of the Bureau of Land Management more public lands will be remanded to Indigenous American communities and be preserved. Director Stone-Manning will focus on recreation, conservation and restoration while healing the wounds left by the extractive and livestock industries by connecting the CM Russell Wildlife Refuge in Montana along the Missouri River to Oacoma, South Dakota combined with wildlife corridors from Yellowstone National Park to the Yukon in the north and south to the Pecos River through parts of Wyoming, Nebraska, eastern Colorado, western Kansas, Oklahoma, New Mexico and Texas.

    Clear the second growth conifers and eastern red cedar then restore aspen and oak habitat, prescribe burns, begin extensive Pleistocene rewilding using bison and cervids, empower tribes, lease private land for wildlife corridors, turn feral horses from BLM pastures onto other public land to control exotic grasses and buy out the welfare ranchers Tony Dean warned us about.

  13. Donald Pay 2021-10-02 09:44

    Cory, define “rural values.” I know what those values used to be, but I think rural America started to lose them somewhere in the 1980’s, during the farm crisis.

  14. O 2021-10-02 10:05

    The COVID death count has gone over 700,000. If those had been embryos, the Right would be outraged and take immediate legislative action.

  15. larry kurtz 2021-10-02 11:37

    Self-reliance is likely the most important rural value. We live on a remote parcel thirty minutes from town but for people in the northeast corner of New Mexico it might as well be Harding County, South Dakota or Carter County, Montana where sorta decent shopping is a hundred miles away. And that includes the resources to do it in January when God hates everybody on the High Plains.

  16. Porter Lansing 2021-10-02 12:19

    Rural areas are not homogeneous.
    -It is critical to recognize that their traditions
    and customs vary from small town to small town, as well
    from farm to town.
    – Most mental health needs are taken
    to family practice physicians, ministers, family, friends, and
    -Such resources, while important, are often inadequate
    to deal fully with mental health problems.

  17. Eve Fisher 2021-10-02 12:29

    Rural America has been petted and courted and told they’re the only “real America” for so long that they believe it, and that urbanites are all liberal degenerate alien socialist welfare junkies who are out to take away their freedom, and that’s why it’s okay for rural votes to count more than urban votes. (All Votes Matter doesn’t fly in rural America.) Meanwhile, they ignore the fact that most of rural America receives more tax $$$ than it pays, and that those tax $$$ are coming from the urbanites they’ve been trained to despise.

    They also ignore the fact that rural America has a tendency to want everyone to behave / believe alike – so the weirdos, i.e., the artists, the LGBTQ crowd, the nerds (like myself), the future scientists, etc., i.e. all the ones who get bullied and mocked and beaten throughout their school years – get out and go to urban centers where they can find jobs, acceptance, education, etc. And when they come back to visit the folks at home, they are generally still treated like crap unless they are suitably apologetic for having left rural heaven just for something so trivial as a good job and a happy life.

  18. O 2021-10-02 14:48

    Given gerrymandering and winner-take-all elections, rural America has become the overrepresented America. It’s not too far to go from there to get to believing rural is “real” America from that representation.

  19. LCJ 2021-10-03 13:35

    So, are you also going to lecture the the the blacks and the native population also? The rates of these people being vaccinated is horrible. Maybe they will have a true and honest person to lead them someday but if history tells us anything, probably not. I am fully vaccinated but recovering still after 4 weeks. Just saying.

  20. O 2021-10-03 15:12

    LCJ, “Just saying” what exactly? Are you just saying your experience is typical? Are you just saying your experience would lead you to not get vaccinated if given the choice again? Are you just saying your experience is worse than getting COVID?

    Also are you claiming that there has not been “true and honest” black or native leaders? Or is that a comparison to the sparkling record of “true and honest” white leaders?

  21. LCJ 2021-10-03 15:43

    In my workplace I have 31 people of not listed as a cracker only.
    Several of them are reluctant to get vaccinated solely on the words of VP Harris and President Mummy Head
    We have not had a great black leader since MLK
    Judge a man not by the color of his skin but by the ?
    Can any of you finish this this from one of the greatest speeches by a black republican ?

  22. Bonnie B Fairbank 2021-10-03 18:21

    mike from iowa: This is medical triage, usually reserved for shorter term medical disasters, such as the Boston Marathon terrorist bombings and battlefield wounds. But, as you astutely pointed out, stoopid magats are forcing health care professionals into making these choices.

    Infuriatingly (to me) when Covid-19 first broke out where I live and nobody knew anything about it and health care professionals were running for cover, I was cutting wood for my woodstove and jammed an enormous splinter through the skin between the thumb and forefinger of my left hand. The Fall River Hospital and the Hot Springs VA Medical Center both told me to “man up” and take care of it myself. Pliers and bad words were involved. Good thing we live in an enlightened country with good health care.

  23. mike from iowa 2021-10-03 18:58

    Ms Fairbank, are pliers medically recognized as appropriate splinter removers? Owtch!!!

  24. Bonnie B Fairbank 2021-10-03 19:19

    Prolly not, but my tweezers weren’t gonna do it. “Owtch!!!” is a very good word to describe my bellowing.

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