Key Findings

Below, we summarize the key findings from our research. These findings make a clear and compelling case for policy interventions to guarantee access to paid family and medical leave and paid sick time as both health and economic development imperatives.

• Among U.S. states with more than 20 percent of the population living in rural areas, none guarantee workers access to paid family and medical leave and only two (Vermont and New Mexico) guarantee access to paid sick time.
• Fewer than half of prime-age workers in rural communities (47.9 percent) are estimated to have unpaid, job-protected leave through the federal Family and Medical Leave Act (FMLA) because rural businesses are more likely to be small and fall outside the FMLA’s coverage and because rural workers are more likely to work part-time and therefore not meet the FMLA’s hours-worked requirements.
• In the absence of legislative requirements or programs, just over half of workers in rural communities (55.7 percent) report having employer-provided paid sick time through their jobs, and both men and women in rural communities are seven percentage points less likely than metropolitan-area workers to have access to paid sick time. Fewer than half of rural workers with a recent cancer diagnosis reported access to paid sick days (49 percent).
• Only six-in-ten women in rural communities (61 percent) report having paid time off of any kind that they can use to care for a new child, an ill loved one, or their own serious health issue—and rural women are about six percentage points less likely than women in metropolitan areas to have access to paid time off to use for these serious family and personal medical needs. Women’s access to paid leave is significant because women continue to do more family caregiving than men. Through the pandemic, other data shows that rural mothers report being particularly stretched, and less likely to have access to paid leave or other types of workplace or caregiving supports.
• People in the rural census tracts that are closest to hospital-based health care services are still further away than people in urban census tracts are to the same kind of health care services.
• Residents of rural communities must travel, on average, far greater distances than people in metropolitan areas to access hospital-based health care services, including:
  • Hospital-based obstetrics care (about three times as far, 24.7 miles for rural census tracts, compared with 8.4 miles for urban census tracts);
  • Neonatal care (nearly five times as far, 50.6 miles for rural census tracts, compared with 10.8 miles for urban census tracts);
  • Hospital-based pediatric care (three times as far, 32.5 miles in rural census tracts compared with 10.7 miles for urban census tracts);
  • Hospital-based cardiology services (nearly four times as far, 30.6 miles for rural census tracts, compared with 8.0 miles for urban census tracts);
  • Hospital-based cancer screenings (nearly three times as far, 20.4 miles for rural census tracts, compared with 7.4 miles for urban census tracts); and
  • Hospital-based cancer treatments (more than three times as far, 26.8 miles for rural census tracts, compared with 7.9 for urban census tracts).
• Skilled nursing facilities are also further distances (three times as far, on average) from rural areas than metropolitan areas, though mileage is much more reasonable than from most hospital-based health care services (10.3 miles for rural census tracts compared to 3.8 miles for urban census tracts).
• People living in rural areas with a high percentage of Latine residents have even further to travel to hospital-based health services than rural residents overall—and rural Latine residents are among the least likely to have access to paid sick time or paid leave for serious family and medical needs.
• People living in areas of persistent poverty face greater challenges, as lack of access to paid leave, combined with longer distances to travel to health care may create greater burdens related to income loss and risks of job loss. We find that rural areas with persistent poverty are slightly further than other rural census tracts from hospital-based obstetrics care and cancer screening and moderately further from hospital-based cancer treatment.

National public paid family and medical leave and paid sick time policies would be the most efficient and fair way to create baseline access to paid leave for all working people in the United States, no matter where they live or their job. State policy interventions and private sector initiatives are also important building blocks to workers’ expanded access to paid leave. Private sector policy and culture changes are especially critical for creating workplaces that are more favorable to workers with caregiving responsibilities or needs.

Expanded access to paid sick time and paid family and medical leave should be a priority for rural policymakers and employers. Ensuring that policies are designed with the needs of diverse rural communities in mind—to cover workers in businesses of all sizes including in small businesses with paid, job-protected leave that replaces a substantial share of income and covers caregiving for extended family members—is essential.

In addition to individual-level reasons to expand workers’ access to paid leave, rural areas are seeking to attract new, younger residents and build vibrant communities with high-quality services. Access to paid leave may further these goals by helping to attract workers, boost labor force participation, and contribute to economic development.