Jennifer Bacani McKenney, M.D., has been a family physician since 2009 in her hometown of Fredonia, Kansas, a community of approximately 2,200 people. Her practice, Fredonia Family Care, provides inpatient and outpatient care, emergency services and more to the residents of Fredonia and the surrounding counties.

Bacani McKenney, who also serves as the associate dean for rural medical education at the University of Kansas School of Medicine, is proud of the care she and her colleagues provide to their patients every day. But a lack of other, non-physician healthcare providers in her rural part of the state causes challenges — particularly the severe shortage of nurses.

“Nurses can make more money now as traveling nurses, and that has really impacted us,” Bacani McKenney said. “That trend has taken many of our nurses away, and we must hire contract nurses, which is much more costly and not as efficient. Travel nurses can be great, but they’re not familiar with our hospital and processes.”

The scope of the problem

The shortage of physicians in rural areas of Kansas and the rest of rural America has been well-documented. Ninety-two of Kansas’ 105 counties lack adequate medical care, and rural Kansas is hit hardest. Fifty Kansas counties are classified as 100% rural by the U.S. Census Bureau. The ratio of healthcare providers per capita in rural Kansas is starkly lower than urban areas; while there are 1.5 physicians (M.D. or D.O., any specialty) per 1,000 people in urban counties, rural counties have only 0.8.

But it is not just the lack of primary care physicians that is causing a crisis in rural areas. The shortage of other healthcare providers — nurses, physical therapists, occupational therapists, cardiologists, surgeons, mental health professionals and more — is also affecting the availability and quality of healthcare available to rural residents.

Tom Mueller, Ph.D., is an assistant professor of population health at the KU School of Medicine and director of the Kansas Center for Rural Health at KU Medical Center.

“We need all hands-on deck when it comes to improving rural health and healthcare,” Mueller said. “We cannot do that without nurses, physical therapists, respiratory therapists, lab technicians, dietitians or any number of our essential health professionals.”

Where are the nurses?

As Bacani McKenney said, the nursing shortage is having almost as big of an impact on the health of rural Kansans as the physician shortage has.

MedPro Healthcare Staffing, a provider of temporary and contract staffing services for healthcare facilities, estimates the U.S. health system will face a critical workforce gap by the year 2030, with more than 1 million nurses needed to cover the healthcare needs of the U.S. population.

“The nursing shortage is not just a statistic,” said Patty Jeffrey, MedPro’s executive vice president. “It’s a challenge affecting patient care in every community.”

The COVID-19 pandemic made the shortage even worse, exacerbating already existing staffing and burnout concerns among the nursing workforce and causing a “dramatic shift” in the profession, according to a 2024 national survey released by the National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers.  Brendan Martin, director of the National Council of State Boards of Nursing, said they surveyed more than 800,000 nurses across the country on why they were thinking of leaving nursing.

“They told us pretty uniformly that the reasons motivating their departure from the workforce were short staffing, high workloads, elevated burnout and stress,” Martin said. “We also saw a pretty notable proportion of nurses reporting workplace violence and bullying, as well as some indicating inadequate salary.”

Closer to home, the Kansas Nursing Workforce Center, which was established by the KU School of Nursing in 2023, has been tasked with documenting the scope of the nursing shortage in Kansas and trying to come up with ways to alleviate the crisis. In late 2025, the center released its second State of Nursing in Kansas report — and the news was not good.

According to the 2025 report, the number of nurses in Kansas has declined since 2019, and the current nursing workforce is aging. More than 21% of registered nurses (RNs) and 20.5% of licensed practical nurses (LPNs) in Kansas are 60 or older — with not enough younger nurses being trained to replace them. And 25.9% of RNs and 23.4% of LPNs are planning to retire or leave the profession in the next five years. The report also notes that the population in Kansas is aging as well — and those aging populations require more care.

“Kansans have increasing healthcare needs as Kansans are aging,” said Barbara MacArthur, MN, RN, FAAN, director of the Kansas Nursing Workforce Center. “It is widely accepted that older adults require more healthcare. From 2010 to 2024, the percentage of Kansans 65 or older has increased from 13.4% to 17.8%.”

The report also shows that over the past 10 years, despite a 12% increase in seats available in pre-licensure nursing programs at Kansas Board of Regents schools, the number of students enrolled in nursing programs has actually declined overall, from 14,543 in 2013 to 9,991 in 2025.

Another challenge is that many nursing schools struggle to attract and retain the faculty members needed to educate the next generation of nurses.

“The KU School of Nursing is, like other schools of nursing, challenged by the shortage of nursing faculty and the shortage of nurses nationwide, said Jean Giddens, Ph.D., RN, FAAN, the dean of the KU School of Nursing. “The pandemic and related burnout issues have exacerbated shortages, and many very senior academic nursing deans and leaders have retired.”

In 2025, the Kansas Board of Regents awarded the KU School of Nursing a $1 million grant to help the Kansas Nursing Workforce Center engage in several projects designed to increase interest in nursing and boost applications to nursing schools throughout the state. The Kansas Nursing Pathways Project aims to increase the number of applicants to pre-licensure nursing programs to address workforce shortages, especially in rural areas. As part of the project, the KU School of Nursing is collaborating with institutions like Wichita State University and Kansas State University to promote BSN-level education throughout the state.

“Potential nursing students struggle to see an educational pathway that fits their needs, and they often spend time and money filling out multiple applications,” MacArthur said. “Nursing education programs have unfilled seats while employers are struggling to find nurses.”

MacArthur added that the Kansas Nursing Pathways Project has a multi-pronged strategy to try to increase enrollment in nursing programs across the state.

“We are piloting the use of a unified application tool with a cohort of LPN, ADN and BSN schools located in urban, community and rural parts of the state with the goal of improving ease of access for students to apply, expand school applications and provide data about multi-school applicants,” MacArthur said. “We hope this will assist potential students, families and guidance counselors in understanding the education opportunities and the career paths that are available to those interested in pursuing a career in nursing.”

Mental healthcare can be hard to find

Approximately one-fifth of people living in rural areas — about 6.5 million individuals — have some kind of mental illness, according to National Institutes of Health data. Though the prevalence of serious mental illness and most psychiatric disorders is comparable between adults living in rural and urban areas, those residing in rural areas receive mental health treatment less frequently. The reasons underlying this disparity include reduced access to providers and limited availability of specialty mental healthcare in rural areas, lack of trained mental health providers and care coordination in rural medical care and underutilization of available services.

The National Alliance on Mental Illness reports that rural Americans experience higher rates of depression and suicide than people who live in urban areas, but they are less likely to access mental healthcare services. Suicide rates among people living in rural areas are 18.3 to 20.5 per 100,000 residents — much higher than rates among people living in large urban areas (10.9 per 100,000).

In fact, data from the alliance shows that 65% of rural counties in the United States lack a psychiatrist; 81% lack a psychiatric nurse practitioner; and 47% lack a psychologist. In Kansas, state data indicates that 85 of the state’s 105 counties are experiencing a shortage of mental health professionals.

Matt Byerly, M.D., is acting chair of psychiatry and behavioral sciences and associate dean for research at the KU School of Medicine-Wichita. Byerly said in rural areas, those dealing with a mental illness often must get treatment from healthcare professionals who are not mental health specialists.

“In fact, the National Center for Health Statistics has found that those living in urban areas who are seeking mental healthcare are being treated by psychiatrists more than 60% of the time,” Byerly said. “However, in rural areas, only 29% of residents dealing with a mental illness are being treated by a psychiatrist.”

Without access to a mental health professional, most rural residents aren’t getting the most effective tools to deal with their illnesses.

“There is no doubt that access to mental health specialists results in better health outcomes for patients,” Byerly said. “And that’s one of the reasons why mental health needs are a top rural health priority nationally.”

Byerly referred to data from the Healthy People Outcomes 2030 initiative that ranked mental health needs as the top priority for rural health shortages. The survey polled rural health stakeholders, and more than 75% cited mental health and mental disorders as a top 10 priority for their communities. Mental health needs beat out other rural health shortage areas such as obesity, dietetics and nutrition, preventative care and geriatric care.

Some rural residents are utilizing telehealth and telemedicine services to access professional mental healthcare, Byerly said. But he said telemedicine is not a solution.

“Telehealth largely seems to be similarly effective in treating mental illness, but access can still be an issue,” Byerly said. “There still aren’t enough providers, and some mental health professionals have been slow to embrace telehealth as an alternative way to treat patients.”

Byerly said there are some initiatives that have a good chance of improving rural access to mental healthcare. For one, where future psychiatrists train is a critical factor in where they end up practicing: data from the American Academy of Physicians shows that 68% of psychiatrists stay in the state where they receive their medical education and serve their residencies. Byerly said currently there are no psychiatric residency training opportunities in Kansas west of Salina. But he hopes that will change.

“We currently have a proposal to create six psychiatric residency positions per year based in Hutchinson, Kansas,” Byerly said. “And there is good evidence that if we can get psychiatrists to serve their residencies in a more rural area such as Hutchison, they are more likely to end up practicing in a rural setting.”

Other health professions shortages

Rural and underserved areas of Kansas are not only experiencing severe shortages of doctors and nurses, but also physical and occupational therapists, dietitians and nutritionists, audiologists, diagnostic scientists and respiratory care therapists, said Dave Burnett, Ph.D., RRT, associate dean of community engagement and workforce initiatives for the KU School of Health Professions.

Those are all jobs for which the School of Health Professions offers graduate, undergraduate and certificate programs.

One KU Medical Center initiative focused on addressing the state’s shortages in those areas is the Underserved Communities Have a Medical Provider — or U-CHaMP — program. U-CHaMP’s goal is to recruit students from economically and educationally underserved backgrounds who have expressed an interest in health professions careers and would be willing to serve in rural and underserved areas. The program is funded by a $3.25 million, five-year grant from the federal Health Resources and Service Administration.

Burnett, principal investigator for the grant, is hopeful that the U-CHaMP initiative will help improve the lives of all Kansans by strengthening the healthcare workforce pipeline to medically underserved areas.

Burnett himself is not a stranger to those communities. In his teen years, he was raised by a single mother in a “very underserved” community in rural Iowa. He recalls once dislocating his shoulder, and it was a challenge to find proper imaging services or anyone to set it. There wasn’t exactly an emergency department across the street, with a physician standing by. He added that, as an active kid growing up on a farm, the shoulder incident wasn’t the only scrape he got himself into.

“I didn’t think a whole lot about it then, but when I look back on it, access to many different healthcare specialties was certainly lacking,” Burnett said.

Burnett said U-CHaMP has experienced outreach and recruitment coordinators who have been fanning out in the Kansas City metropolitan area and across Kansas. Students who are juniors and seniors in high school or enrolled in undergraduate programs across Kansas can apply to become U-CHaMP ambassadors. If accepted to one of the KU School of Health Professions degree programs, they can also apply to be U-CHaMP Scholars and earn a scholarship up to $10,000 per academic year.

“This will help provide academic, social and financial support to students from disadvantaged backgrounds and those in underserved communities,” Burnett said.

As part of the scholars’ program, the School of Health Professions is also developing what will be its first-ever rural residency program, slated to begin in 2026, Burnett said.

KU is partnering with the Community Health Center of Southeast Kansas, which has locations in more than a dozen small towns. Burnett said the School of Health Professions inquired about the center’s greatest need and learned it could use support in chronic respiratory disease management, such as chronic obstructive pulmonary disease, or COPD.

A KU respiratory therapy student will help the center by assisting in diagnosing patients’ disease severity levels and helping implement a chronic disease management program, Burnett said. The center will help that student by providing an opportunity for hands-on experience.

“It becomes a true partnership because they’re working to help us train our students within that particular field, and we’re helping them train their staff on being able to deliver and implement chronic disease management programming,” Burnett said. “That is a win-win.”

Expanding rural access to healthcare

Another initiative to improve rural healthcare in Kansas is supported in part by a $12 million grant from the Patterson Family Foundation awarded to KU Medical Center and The University of Kansas Health System. The new program brings together research, rural outreach and clinical care from both organizations to improve, measure and increase healthcare in rural Kansas.

Rural communities are the heart of Kansas, and they deserve access to the right care at the right time, Jessica Hunt, vice president of strategy and programs at the Patterson Family Foundation, said in announcing the grant in October 2025

“This effort expands telehealth connections and specialty care access, working alongside rural providers who are vital to helping their communities thrive,” Hunt said.

As part of the venture, researchers from the Kansas Center for Rural Health at KU Medical Center will conduct a statewide assessment of specialty and sub-specialty care, as well as therapies and testing needed to support this care. Based on that assessment, teams from the health system’s Care Collaborative and defined medical specialty areas will work with Care Collaborative members, who are rural healthcare providers, to coordinate diagnostic and therapeutic services closer to patients’ homes.

“Our researchers and care providers are working side by side to find solutions to health-related issues,” said Steve Stites, M.D., executive vice chancellor of KU Medical Center. “This project is just one of the many ways the University of Kansas is making a difference to improve the health of Kansans, especially for those in rural areas.”

What will the future bring?

Although KU, along with the state and federal governments, are trying to promote programs that encourage more students to consider practicing in rural and underserved communities, the shortage is still at a crisis level — and is expected to get worse before it improves.

“We still aren’t putting enough resources into rural communities. Grassroot efforts are occurring, but they haven’t been enough to make a huge difference in the problem so far,” said Bacani McKenney. “Rural communities continue to shrink, and less people in those communities means less of a chance that healthcare professionals will want to move there and practice.”

But Bacani McKenney struck a note of optimism about the future of healthcare in rural America.

“My hope is that as generations change, healthcare might be approached in a different way by students,” she said. “I see it already happening. Many of our students think practicing in rural areas is kind of cool now. I hope we can build on that.”

Sara Shepherd contributed to this story.