Making Telehealth Work for Rural Patients

Imagine driving three hours just to see a specialist. Between taking time off work, finding transportation, and spending most of the day traveling, one appointment is an incredibly exhausting process. But that same appointment from home? No long drive, no missed day of work, and access to a doctor who might otherwise be out of reach. For rural communities that have long struggled with limited healthcare options, telehealth seems like an obvious improvement. But could making healthcare easier to reach also make it harder to keep close to home? 

The appeal of telehealth is easy to understand. Patients can speak with specialists who may not be available nearby, keep up with follow-up appointments, and get care that might otherwise require a long trip. But having these options doesn't necessarily mean everyone can use them. Between 2021 and 2023, just 26.3% of mental health visits in nonmetropolitan areas took place through telehealth, compared with 48.9% in metropolitan areas [1]. Those numbers don't tell the whole story, but they do raise questions about who is actually benefiting. For some patients, avoiding a long drive might mean dealing with unreliable internet, limited technology, or a lack of privacy instead. 

And even when a virtual appointment is possible, it isn't always what a patient wants or needs. Rural primary care patients have expressed the importance of being able to choose between virtual and in-person visits [2]. That choice matters. A quick video call might be perfect for discussing test results, but it won't work for every medical concern. Virtual primary care has shown promising results in some areas, although questions about safety and equity remain [3]. The goal should be to give patients more ways to receive care, not make them dependent on one. 

Then there's a concern that goes beyond the appointment itself. What happens to rural healthcare when more patients start turning to larger hospitals and healthcare systems outside their communities? While telehealth can make it easier to reach urban specialists, it can also shift visits and payments away from local providers. Virtual visits may replace care that patients would have received locally, while others can lead to additional visits with urban providers [4]. For clinics already operating with limited resources, that shift could create even more financial pressure. A patient might gain easier access to a specialist today, only to find fewer healthcare options close to home in the future. 

But telehealth doesn't have to work this way. Rather than pulling patients away from rural clinics, it can help those clinics offer more. Imagine a patient visiting a local practice, where staff help them connect with a specialist at a larger hospital. The specialist provides expertise that isn't available nearby, while the local team remains involved in testing, treatment, and follow-up. 

Partnerships between rural clinics and larger healthcare systems can make this kind of coordination possible [5]. In this case, telehealth isn't replacing rural healthcare. It's helping make it stronger. Rather than simply expanding virtual appointments, healthcare providers should focus on giving patients more options while supporting the local services they still depend on. Bringing a doctor closer through a screen shouldn't mean pushing the rest of a community's healthcare further away.

Designed by: Sohail Bhagat

Reviewed by: Manu Datta

References

[1] Decker, S. L. (2025). Use of telehealth in nonmetropolitan and metropolitan areas, United States 2021–2023. Agency for Healthcare Research and Quality. 

https://meps.ahrq.gov/data_files/publications/st570/stat570.shtml.

[2] Goldstein, K. M., et al. (2022). How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients. BMJ Open, 12(8), e062261. https://bmjopen.bmj.com/content/12/8/e062261.

[3] Campbell, K., et al. (2023). The impact of virtual consultations on the quality of primary care: Systematic review. Journal of Medical Internet Research, 25, e48920. https://www.jmir.org/2023/1/e48920.

[4] Zhou, M., Li, X., & Burtch, G. (2024). Healthcare across boundaries: Urban-rural differences in the consequences of telehealth adoption. Information Systems Research, 35(3), 1092–1113. https://pubsonline.informs.org/doi/10.1287/isre.2021.0380.

[5] U.S. Department of Health and Human Services. (2025, July 29). Developing a rural telehealth workflow and strategy. 

https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-rural-areas/developing-rur al-telehealth-workflow-and-strategy.