Donald Trump’s support in rural America appears to have virtually no ceiling. In last month’s election, Trump won country communities by even larger margins than he did in his 2020 and 2016 presidential runs. But several core second-term policies that Trump and the Republican Congress have championed could disproportionately harm those places.
Agricultural producers could face worse losses than any other economic sector from Trump’s plans to impose sweeping tariffs on imports and to undertake what he frequently has called “the largest domestic deportation operation” of undocumented immigrants “in American history.” Hospitals and other health providers in rural areas could face the greatest strain from proposals Trump has embraced to slash spending on Medicaid, which provides coverage to a greater share of adults in smaller communities than in large metropolitan areas. And small-town public schools would likely be destabilized even more than urban school districts if Trump succeeds in his pledge to expand “school choice” by providing parents with vouchers to send their kids to private schools.
Resistance to such measures in deep-red rural areas could represent one of the few obstacles Trump would face from a GOP-controlled Congress over implementing his agenda. Still, the most likely scenario is that elected Republicans who represent rural areas will ultimately fall in line with Trump’s blueprint. If so, the effects will test whether anything can loosen the GOP’s grip on small-town America during the Trump era, or whether the fervor of his rural supporters provides Trump nearly unlimited leeway to work against their economic interests without paying any political price.
“I don’t think [the Trump agenda] is going to lead to a dramatic reversal of these partisan shifts, because the truth is that the disdain for the Democratic Party is decades in the making and deep in rural America,” Nicholas Jacobs, a political scientist at Colby College and the author of the 2023 book The Rural Voter, told me. But if Trump acts on the policies he campaigned on, Jacobs added, “it’s hard to imagine that rural [places] will not suffer and will not hurt, and it’s hard to imagine that rural will not respond.”
Trump’s support in rural places reached imposing proportions in last month’s election, with gains even in heavily Latino rural counties in the Southwest and some Black rural areas in the Southeast. The nonpartisan Center for Rural Studies has developed a six-category classification system that segments the nation’s roughly 3,100 counties from the most urban to the most rural. The center found that in the second most-rural grouping, small metropolitan areas, Trump won 60 percent of the vote compared with Vice President Kamala Harris’s 40 percent. In the top most-rural category, nonmetropolitan areas, Trump beat Harris even more resoundingly, by 69 percent to 31 percent.
Trump’s vote share in the nonmetro areas exceeded even his commanding 66 percent there against Joe Biden in 2020 and 67 percent against Hillary Clinton in 2016. Trump’s advantage in the small metros outstripped his margin over Biden and equaled his advantage over Clinton.
Across his three runs for the White House, Trump gained considerably more support in the most-rural counties than in the nation’s more populous communities. Although he ran no better in the most-urban counties than did the 2012 Republican nominee, Mitt Romney, Trump roughly doubled the GOP margin in nonmetro areas from 20 points in 2012 to nearly 40 this year. In the small metros, Trump’s 20-point lead in 2024 represented a significant increase over Romney’s 12-point advantage.
Congressional elections have largely followed the same trajectory. Once, rural areas were the political base for economically moderate, culturally conservative “blue dog” Democrats in the House, but since the GOP sweep in the 2010 midterm elections, Republicans have hunted the blue dogs to virtual extinction. Maps of party control of House seats now show the countryside solidly red in almost every state. Barring a few exceptions in New England, the states where rural residents compose the largest share of the population preponderantly elect Republicans to the Senate as well.
As Jacobs noted, the GOP advances in small-town America feed on these communities’ deep sense of being left behind in a changing America. Trump, as a thrice-married New Yorker who has lived much of his life in a Fifth Avenue penthouse, has always seemed an unlikely tribune for rural voters, yet his connection with them is visceral. After years of seemingly inexorable decline in more remote communities, Jacobs believes, rural residents are especially responsive to Trump’s attacks on “elites” and his promises to upend the system. “I think rural people are rejecting the idea that the devil we know is worse than the devil Trump may bring,” Jacobs told me.
Despite the appeal of Trump’s promise of “retribution” against the forces these people believe have held them back, the change he’s offering in the specifics of his second-term agenda may strain those ties. The potential conflicts begin with Trump’s plans for trade. Agricultural producers faced the most turmoil from the tariffs that Trump in his first term slapped on numerous trading partners, including China, the European Union, Mexico, and Canada. Trump bought peace with farm interests by disbursing more than $60 billion in payments to producers to compensate for the markets they lost when China and other countries imposed retaliatory tariffs on U.S. products such as soybeans, corn, and pork. Those payments consumed nearly all of the revenue that Trump’s tariffs raised, according to an analysis by the Council on Foreign Relations.
Trump’s payments to farmers preempted any large-scale rural revolt during his first term. But they nonetheless imposed long-term costs on agricultural producers.
The bruising trade conflicts of Trump’s first term encouraged foreign purchasers of American farm products to diversify their supply in order to be less vulnerable to future trade disruptions, Sandro Steinbach, the director of the Center for Agricultural Policy and Trade Studies at North Dakota State University, told me. As a result of Trump’s trade conflicts, Steinbach said, the United States lost share in those markets and never recovered it. In 2016, for example, the U.S. sold nearly as many soybeans to China as Brazil did; now Brazil controls three times as much of the Chinese market. “China is demanding more commodities” but is buying them from other suppliers, Steinbach said, “and that means we left a lot of money on the table.”
All of these disruptions came from Trump’s relatively targeted first-term tariffs on imports. He’s now threatening much more sweeping levies, including a 10 percent tariff on all imports, rising to 60 percent on those from China and 25 percent for goods from Mexico and Canada. Steinbach believes farmers will “very likely” now face even greater retaliatory trade barriers against their produce than they did in Trump’s first term. “The worst-case scenarios are really bad,” he told me.
Farm lobbies are welcoming Trump’s pledge to slash environmental regulations and hoping that he can deliver on his promise to cut energy costs. But his determination to carry out the mass deportation of undocumented immigrants will create another challenge for farmers. Agriculture relies on those workers as much as any other industry: Varying estimates put the proportion of farm laborers who are undocumented at one-sixth to nearly a quarter; they also make up large workforce shares in other industries along the food chain, such as meatpacking.
Removing a significant share of those workers through deportation, Steinbach said, would further erode the international competitiveness of American farmers by raising their labor costs and thus the price of their products. Eliminating undocumented workers would also put upward pressure on domestic food prices—after an election that, as Trump himself noted, he won largely because of the price of groceries—and would also weaken rural economies by removing those workers’ buying power.
“It is a stretch to think that if you start deporting undocumented labor, rural people who are hanging out in town are going to step in and fill those jobs, or people are going to move back to the countryside,” Jacobs told me. “There is very little evidence to suggest the labor market would self-correct in that direction.”
A recent attempt to model how Trump’s tariff and mass-deportation plans would affect agricultural producers found a devastating combined impact. In a scenario where Trump both imposes the tariffs he’s threatened and succeeds at deporting a large number of immigrants, the nonpartisan Peterson Institute for International Economics has forecast that by 2028, agricultural exports could fall by nearly half and total agricultural output would decline by a sixth. Mass deportation, the institute projected, would reduce the workforce for agricultural production more than for any other economic sector. This forecast underscores Steinbach’s astringent assessment: “Any of those policies will be pretty painful in the short run for rural America.”
Equally painful for rural America could be Trump and congressional Republicans’ agenda for health care. Big cuts in federal spending on Medicaid and subsidies for the uninsured to buy coverage under the Affordable Care Act were central to the Trump-backed plan that House Republicans passed in 2017 to repeal the ACA. Trump’s administration later backed a Senate Republican proposal to convert Medicaid into a block grant and significantly cut its funding.
Retrenching federal spending on Medicaid and the ACA remains a priority for congressional Republicans. Trump has consistently excluded Medicaid when he’s pledged not to seek cuts in the other biggest federal safety-net programs, Social Security and Medicare. The Republican Study Committee, a prominent organization of House conservatives, called in its latest proposed budget for converting Medicaid and ACA subsidies into block grants to states and then cutting them by $4.5 trillion over the next decade, more than four times the scale of cuts passed by the House in its 2017 bill.
“At the level of cuts some of these groups are talking about, we are not looking at making things more efficient,” Larry Levitt, the executive vice president for health policy at the nonpartisan KFF think tank, told me. “We are looking at cutting tens of millions of people off from coverage.”
Rural places would be especially vulnerable to cuts anywhere near the level that Republicans are discussing. Rural residents tend to be older and poorer, and face more chronic health problems. Rural employers are less likely to offer health insurance, which means that Medicaid provides coverage for a larger share of working-age adults in small towns: Multiple studies have found that about a fifth of rural residents rely on Medicaid, compared with less than a sixth in urban areas. Nearly half of all children in rural areas receive health coverage through the federal Children’s Health Insurance Program launched during Bill Clinton’s presidency.
Medicaid is especially important in confronting two health-care challenges particularly acute in rural communities. One is the opioid epidemic. In a KFF poll last year, more than 40 percent of rural residents said that they or someone in their family had been addicted to opioids, a far higher proportion than in urban or suburban communities.
Medicaid has become the foundation of the public-health response to that challenge. One recent study found that Medicaid provides treatment for about 1.5 million opioid users every year. Particularly important in that effort has been the ACA’s expansion of Medicaid to cover more working-poor adults who are just above the poverty level. Hundreds of thousands of people are receiving opioid-addiction treatment under Medicaid in heartland states that Trump won, such as Michigan, Pennsylvania, Ohio, Kentucky, and Indiana. In all of those states, a majority of people receiving care are covered through the Medicaid expansion, the center-left Urban Institute has calculated. “A lot of effort has gone into beefing up the community-based resources for mental health and substance abuse, and Medicaid has been the linchpin in the financing for that,” Cindy Mann, a health-care attorney who oversaw the Medicaid program during Barack Obama’s administration, told me.
One of the options most discussed among Republicans for reducing Medicaid spending has been to eliminate the extra federal money (the so-called enhanced match) that Washington has offered states to cover more of the working poor under the ACA. If that money is withdrawn, states would face enormous fiscal pressure to reduce such coverage. That would directly undercut the financing that Medicaid has provided for responding to the opioid epidemic, something that Trump has pledged to prioritize.
Medicaid is also a linchpin in the struggle to preserve rural hospitals. These face much more financial stress than medical facilities in more populous areas. Mann says that over the past two decades, 190 rural hospitals have closed or converted to other purposes, and nearly a third of the remaining facilities show signs of financial difficulty.
Private insurance, Mann notes, doesn’t provide as much revenue for rural hospitals as it does for urban ones, because fewer rural residents have such coverage to begin with; even for those who do, rural providers lack the economic leverage to demand reimbursement rates that are as high as private insurers provide to urban hospitals. That situation makes Medicaid a crucial lifeline for rural hospitals. “With large cuts to federal health spending, it would be very hard for rural health-care providers to simply survive,” said the KFF’s Levitt. “In many cases, rural hospitals are hanging by a thread already, and it wouldn’t take much to push them over the edge.”
In the same way that rural hospitals are especially vulnerable to Trump’s health-care agenda, his education plans could threaten another pillar of small-town life: public schools. Trump has repeatedly promised to pursue a nationwide federal voucher system that would provide parents with public funds to send their children to private schools.
In numerous state ballot initiatives over recent years, rural residents have voted against proposals to create a school-voucher system. That record continued last month when rural areas again mostly voted against voucher systems in ballot initiatives in Nebraska and Kentucky. (In Colorado, rural areas split about evenly on a similar proposition.)
Kelsey Coots, who managed the campaign against the Kentucky voucher initiative, told me that the proposal was rejected even in culturally conservative rural counties “because everyone in the community is connected to the school.” Small-town residents, she said, recognized that rural public schools already facing financial strain from stagnant or shrinking enrollments have little cushion if vouchers drain more of their funding. Regardless of how receptive conservative rural voters might be to Republican attacks on “woke” educators, Coots noted, “if you ask them about their public school or their neighborhood school, they like it, because they know what the public school means for their community.”
Throughout three elections, Trump’s messaging—particularly his hostility to racial and cultural change—has resonated strongly in rural communities. His second term may test whether that deep reservoir of ideological support can survive policies that threaten the material interests of rural America in so many ways.
