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Rural America and the Affordable Connectivity Program (ACP)

Of the 28 million households in the U.S. that lack broadband internet in their home, 18 million say it is because they cannot afford an internet connection.

For rural Americans, that lack of affordability – paired with the rural-urban digital divide – often means insurmountable challenges to accessing an affordable connection to the internet.

In September of 2023, the Rural & Agriculture Council of America (RACA), the National Grange, RuralRISE Tech, and the U.S. Cattlemen’s Association sent a letter to Congressional leadership urging renewal of the Affordable Connectivity Program (ACP). 

Let’s look at the program and how it can help rural communities. 

What is the ACP?

The Affordable Connectivity Program is an FCC program that focuses on broadband affordability for American households. 

A young Black girl sits at a laptop. The text on the image reads, "Affordable Connectivity Program, Helping Households Get Access to Broadband"

The benefit provides a discount of up to $30 per month toward internet service for eligible households and up to $75 per month for households on qualifying Tribal lands.

Eligible households can also receive a one-time discount of up to $100 to purchase a laptop, desktop computer, or tablet from participating providers if they contribute more than $10 and less than $50 toward the purchase price.

Why Does it Matter for Rural America?

Excerpting from the letter, emphasis ours:

Overwhelmingly, rural communities’ connectivity has been categorized as a long-term problem to address. These Americans have been overlooked as lawmakers view the digital divide through the simplistic, narrow lens of “who can we help with the most immediate impact”. 

This is because the historical narrative around broadband access holds that households are unconnected because they simply lack access to high-speed internet infrastructure. Indeed, broadband deployment has been toughest in hard-to-reach areas, which in turn causes high costs for internet on rural consumers. 

However, the ACP has alleviated such high costs through providing a discount. This affordability initiative ensures the billions of federal dollars that Congress and The White House have designated to states help build out more broadband infrastructure, through the Broadband, Equity, Access and Deployment (BEAD) Program, are going to have a tangible impact for the Americans who need it most. 

So, what can you do to support the program?

Help Get the Word Out

There are a number of ways to support the ACP, including reaching out to your representatives in the House and Senate. 

You can read the letter of support here. You can help your community get enrolled, and share the information with others in rural areas. You can also learn more about the program, including eligibility and enrollment information, by visiting https://www.fcc.gov/acp or calling 877-384-2575.

Why Does Telehealth Access Matter for Rural Broadband?

One-quarter of Americans live in rural areas, but fewer than 10% of U.S. physicians practice in those communities. This shortage of healthcare professionals in rural areas of our country restricts access to healthcare by limiting the supply of available services. 

Residents of rural communities deserve the same quality of care to which their metropolitan peers have access. To compensate for this resource gap, healthcare providers are extending telehealth services. 

But these efforts are coming up against an additional resource gap — broadband internet connectivity.

Rural broadband connectivity is essential for telehealth expansion, but of the 61 million people residing in rural areas, only 58% of adults have a reliable, high-speed broadband connection at home. (Compare this to 67% in urban and 70% in suburban areas.)

The debate is no longer whether telehealth access benefits residents of rural communities but what is the most effective and impactful way to connect rural communities to the broadband services necessary to provide telemedicine.

Let’s examine the connection.

Telehealth Expansion Necessitates Broadband Expansion

The lag in broadband connectivity experienced by rural communities comes in many forms, including:

  • Less robust or fewer types of broadband infrastructure available, 
  • High cost of installing broadband infrastructure, and 
  • Unreliable broadband speeds (required to enable innovations in healthcare).
A telehealth provider sits on a green couch with a laptop sitting on a table in front of her.

A recent study found that only 38.6% of the people who live more than a 70-minute drive from a primary care physician subscribe to an internet connection capable of handling telehealth services.

To expand the reach of telehealth services into non-metropolitan communities, we must begin by laying the broadband infrastructure necessary to offer those services.

Broadband Expansion Empowers First Responders

The expansion of broadband coverage benefits emergency responders as well as the citizens they serve.

First responders are essential to the protection of public health and safety. When they enter rural communities, they require reliable connectivity to communicate with one another and seek additional resources for response.

A blue 6-pointed asterisk sign with the word AMBULANCES on it.

FirstNet has created a predictable network of connectivity in rural communities to empower first responders. FirstNet is a nationwide high-speed wireless broadband network deployed on 20 MHz of high-quality spectrum that is constantly evolving to meet public safety needs. 

When not in use for an emergency, the FirstNet network is used for other commercial purposes (though first responders will always have priority over others during an emergency).

Two benefits of the FirstNet and telehealth connection are:

  1. Enhanced communications for first responders to dispatch an ambulance to a location once the call is received by the consumer/citizen (fairly weak connection).
  2. The network provides high-quality wireless service to many previously unserved rural areas across the US. This wireless broadband can support telehealth activities like online doctor appointments when not in use for an emergency.

But local communities often lack the resources necessary to bring broadband to their areas. That’s where the federal government can help.

Federal Expansion of Broadband Connectivity and Telehealth Access

Recognizing the need for rural communities to 1) improve broadband access and then 2) establish telehealth provisions, various federal programs have increased opportunities and support for public health organizations to establish broadband connectivity.

The US Capitol Building at sunset, where federal programs have been created to aid rural residents access affordable broadband internet.

There are a number of federal programs providing pathways to affordable broadband. Below are a few that emphasize rural broadband access:

The Office for the Advancement of Telehealth is working to improve health care in rural, urban, and underserved communities. In particular, their telehealth grant programs promote and advance telehealth services in rural areas.

The FCC’s Connect2Health Task Force (C2HFCC) is engaged in ongoing efforts to provide expert input and information to stakeholders from a variety of states throughout the country about the importance of broadband and broadband-enabled technologies (e.g., telemedicine, remote monitoring, etc.) in health care at various telehealth resource center annual conferences.

The Rural Health Care Program (which the FCC also oversees) provides funding to eligible healthcare providers for telecommunications and broadband services necessary for the provision of telehealth. This program aims to improve the quality of healthcare available to patients in rural communities by ensuring eligible healthcare providers have access to telecommunications and broadband services. 

The National Map of Telehealth Resource Centers provides assistance, education, and information to organizations and individuals who are actively providing or interested in providing health care at a distance.

The Rural Health Information Hub has created a list of current efforts providing telehealth funding for rural healthcare providers.

The American Connectivity Program (ACP) is a nationwide initiative that helps households afford the broadband they need for work, school, healthcare, and more.

But access isn’t the end of the story.

Digital Literacy’s Impact on Telehealth

Digital literacy refers to a user’s ability to navigate information and communication technologies to find, evaluate, create, and communicate information. This skill is critical when navigating telehealth — like every other skill set, we can teach digital literacy!

It is not enough to simply equip rural communities with broadband infrastructure. To maximize the impact of broadband expansion, users need to understand how to actually use the internet.

A pair of hands holds a tablet. The screen reads CONNECT and shows different social media icons.

Several initiatives are already in place to improve digital literacy, particularly in rural areas. And some digital literacy programs focus on serving marginalized communities in rural areas.

For example, the elderly community are frequent healthcare users and can benefit significantly from improved access to telehealth, but only if they feel confident and comfortable navigating the resource online.

While telehealth and telemedicine are on the upswing in rural America, there’s still much work to be done before equitable access is the norm. So how can you help?

Bringing the Benefits of Telehealth to Rural America

Telehealth is an effective way to combat the harm of reduced resources in rural areas, but only if those communities are connected to the Internet. Establishing robust broadband connectivity in rural communities will strengthen telehealth services that have a direct, positive impact on rural residents.

But getting to a place where all Americans can access broadband and services like telemedicine will take continued care and effort. That’s where you come in.

Do you or your organization work in telehealth? 

Do you work to bridge resource gaps like broadband connectivity in rural communities? 

Have you struggled with or benefitted from these services as a consumer?

We would love to hear from you and continue the conversation. When we get together to talk about the impact of programs closing the urban-rural healthcare divide, it helps communities understand successful programs and program pitfalls, among other benefits.

Join in the conversation on Twitter or in our LinkedIn or Facebook groups.

Telehealth and Telemedicine: What Are the Benefits for Rural Patients?

Individuals living in rural communities want to stay there. And why not! Ask most rural residents, and they’ll have a long list of the reasons they love their rural community.

And nearly 80% of rural small business owners agree the quality of life and cost of living is much better in rural areas, according to the U.S. Chamber Technology Engagement Center. 

All this is true despite the ways rural communities quantitatively lag behind their metropolitan counterparts — for example, access to healthcare providers like hospitals, primary doctors, and specialists. 

Access to healthcare is necessary for a thriving community, and residents in rural areas deserve equal access to quality healthcare. So how do rural areas overcome any gaps in healthcare access?

Telehealth offers impactful methods of providing healthcare and outreach to rural communities.

What Is Telehealth?

The telehealth definition used in this article is the delivery of healthcare to individuals over a high-speed internet connection.

What is telemedicine? A healthcare practitioner speaks to a patient via videoconferencing. The patient is holding her hands up to her throat as she describes her symptoms.

In addition to having virtual meetings with healthcare providers, other types of services include: 

  • telemedicine (the provision of remote medical care via the Internet and video conferencing), 
  • electronic medical record keeping, and 
  • portal technology and videoconferencing. 

Remote health monitoring tools such as wearables and biosensors that track and report personal health information have also become commonplace for remote health care. 

Combined, these methods of communicating with healthcare providers help close the rural-urban healthcare access divide. 

Before we examine the benefits of telehealth in rural areas, let’s talk about rural healthcare in general.

What Does Healthcare Look Like in Rural Communities?

Regardless of community size, access to routine healthcare and preventative care have long-term, positive impacts on a person’s health. Additionally, when healthcare resources are commonplace, a community flourishes.

The outside of a rural hospital, showing the brick facade and vehicles lined up at the entrance.

Rural communities, however, are experiencing barriers to commonplace healthcare provisions. Unfortunately, hospitals across rural America are closing at an alarming rate. 

According to the U.S. Government Accountability Office, over 100 rural hospitals closed from 2013 to 2020, forcing people living in those areas to travel farther to get the same healthcare services — about 20 miles farther for services like inpatient care and double that for services like alcohol or drug abuse treatment.

People living in rural communities have limited access to healthcare institutions, travel long distances to receive care, and (because of these factors) often delay needed care until after they have a health emergency. The cost associated with traveling for medical care puts an additional burden on rural patients that may discourage them from seeking care. 

Limited access to healthcare can result in poor health outcomes and is a social and economic burden for both the patient and the healthcare system at large. 

Advancements in telehealth – and expanding those services to rural communities – can be used to make up for expanding gaps in health services.

What Are the Benefits of Telehealth in Rural Communities?

People in rural America are growing increasingly comfortable with telehealth and telemedicine.

A woman sits beside a child on a couch, holding a thermometer. There is a tablet sitting on the table in front of them as they wait for a telemedicine appointment.

Telehealth is already an effective approach for doctors to monitor their patients’ chronic conditions, like heart or lung disease. Better monitoring can improve quality of life and reduce hospital admissions and deaths from chronic diseases.

Rural hospitals have fewer resources to provide their patrons, such as specialists or outpatient programs. But telehealth empowers rural hospitals to partner with larger hospitals, work with established online programming for outpatients, and connect to specialists in other communities to make up for these gaps in service. 

Telehealth resources facilitate communication between hospitals, which impacts patient care through communication, recommendations for ongoing care, organ donation, patient transport, and more. 

The CDC recognizes telehealth as a critical resource for healthcare, both now and in the future, especially for providing care specifically to rural Americans. Because of this, the organization offers various telehealth services targeting common health issues common to rural residents. 

One example is the CDC telehealth stroke services which connect hospitals in rural areas with telehealth doctors and specialists outside of their communities to improve the outcomes of patients receiving treatment after experiencing a stroke.

In an effort to expand telehealth to institutions, the CDC has created case studies (HabitNU, Inova, and Inspera Health) that describe successful program structure, technologies used, and implementation steps, along with lessons learned.

But every rural resident isn’t comfortable with talking to their doctor without being face to face.

Why Are Rural Residents Wary of Online Telehealth? 

Telehealth is a relatively new healthcare field, and some patients are suspicious of its drawbacks.

Two men, a doctor and a patient, sit in an examination room looking at an X-ray.

According to one review of telehealth interventions and outcomes across rural communities, disadvantages of telehealth interventions included having telemedicine visits with unknown providers and technological issues such as loss of connectivity and limited Wi-Fi access. 

Rural residents place a high value on members of their own communities and can be wary of meeting with unfamiliar healthcare providers. 

However, acceptance of telehealth during the pandemic accelerated to the point that many barriers to telemedicine use – including trust – may have begun to disappear. Furthermore, telehealth is now available almost everywhere, meaning patients can connect to primary care providers with whom they have an established relationship!

However, along with the other limitations and challenges of telehealth, we can’t forget that the foundational requirement of affordable, accessible broadband and cellular connectivity remains an obstacle.

So, where do rural areas go from here?

Telehealth in Rural Areas: What’s Next?

As telehealth improves, individuals across rural America are empowered to seek healthcare providers more often, preventatively, and consult specialists that meet their unique needs. 

One review concluded that telemedicine in rural areas decreases travel time, improves communication with providers, increases access to care, increases self-awareness, and empowers patients to manage their chronic conditions. These benefits are critical to residents in rural communities. 

Rural providers also benefit from telehealth as institutions are empowered to expand their provisions by connecting their patients to telehealth resources, decreasing missed appointments and patient wait times, as well as improving patient care quality. 

While limitations of telehealth exist, the field is quickly improving and expanding patient care across the country, with unique benefits available to rural communities. Conversations about the impact of programs that close the urban-rural healthcare divide help communities understand successful programs and program pitfalls.

Do you or your organization work in telehealth? What is your experience with telemedicine? We would love to hear from you and share additional resources. We invite you to share your experiences by commenting here and visiting us on Twitter (@RuralRISE).

How Replenishing America’s Spectrum Pipeline Will Result in Better Rural Wireless Service

The wireless industry has been on a journey to continuously improve networks since its inception two decades ago. The newest generation of wireless technology, 5G, is designed to enhance some of the current industrial technology rural America runs on. 

As wireless technology continues to improve, the networks themselves will need more wireless spectrum. Additional wireless spectrum for 5G networks will enable farmers to monitor crops, inspect soil conditions, and measure carbon levels at faster and more reliable speeds than ever before. 

But what does that mean for rural residents?

5G Will Revolutionize Rural America 

5G technology delivers fast download speeds and quick connection times in areas currently deploying 5G networks. For rural areas, everything from education to healthcare will be revolutionized once 5G networks are deployed and accessible to rural users. 

For remote learners in rural communities, 5G mobile broadband helps close connectivity gaps so students can connect to educational resources anywhere. 

A person types on a laptop with a stethoscope next to them. Healthcare will be positively impacted by improved 5G coverage.

In healthcare, professionals use 5G to monitor diagnostics, manage hospital inventory, and even support robot-assisted surgery. This is game-changing in rural areas where patients are driving as much as 2 hours to access quality healthcare, then are sometimes unable to return to that provider for follow-up appointments or necessary ongoing therapies.

With 5G networks, the innovations are exciting, and the opportunities are endless. We know what’s next for rural residents with 5G: dependable precision agriculture data collection, consistent access to first-class learning materials and practices, and improved healthcare.

But how do we get there and make these exciting 5G innovations possible? 

Replenishing the Spectrum Pipeline

To keep America competitive, we should start by replenishing America’s pipeline of wireless spectrum. 

Think of spectrum as communications signals that power everything from mobile phones to satellite TV. Spectrum also supports 5G networks, delivering profound social, economic, and environmental benefits to small and rural communities. 

A cell phone with 5G wireless and several apps on the screen.

Unfortunately, the United States is out of step with our competitors when it comes to spectrum policy. Simply put, America’s pipeline of wireless spectrum is running out, and we risk losing out on cutting-edge innovations unless we fill the gaps. 

A new report from Accenture found that the commercial wireless industry holds just 5% of lower mid-band spectrum – compared to 61% held by the government. 

Mid-band spectrum is best for deploying 5G technology and innovation across rural America. To do so, the wireless industry must play a more active role, and government should repurpose valuable spectrum so wireless assets are managed more efficiently.

Replenishing the spectrum pipeline begins by identifying spectrum bands that can be repurposed from government use for commercial 5G and used to their full potential. 

One place to look is the 3.1 to 3.45 GHz band. This band’s large coverage range makes it ideal for supporting 5G and fixed wireless access in rural areas. 

Another reason is mid-band spectrum boasts speeds similar to broadband internet in some instances, which makes it a convenient solution for rural residents without home internet. 

Closing the Rural Digital Divide is Within Reach

Delivering fiber internet service to the home is the gold standard of connectivity, but deploying fiber across the U.S. will take time. No one should have to settle for sub-par service or sit outside a local library simply to access the internet.

Luckily, 5G has an immediate role to play in filling connectivity gaps. Accenture estimates that industry’s 5G fixed wireless deployments could serve nearly half of rural households in a much shorter timeframe. 

Necessary tools to close the rural digital divide are out there. Millions of households, thousands of businesses, and countless entrepreneurs living in small and rural communities across America are ready to innovate, but they need wireless tools to get started. 

5G does not come without challenges. But regardless of your thoughts on 5G, it will be a component in closing the rural digital divide along with other solutions. 

We’re calling on policymakers to replenish the spectrum pipeline so 5G can unlock next-generation innovations for rural America.

​​How the Rural-Urban Divide Impacts Digital and Technology Literacy

As most people know, traditional literacy refers to reading, writing, and the skills needed to perform those tasks, such as phonetics, context clues, and a willingness to think critically about communication.

As a society, we are developing a more modern type of scholarship – digital literacy – which takes literacy skills and applies them to technology. 

Digital literacy, sometimes called technology literacy, uses information and communication technologies to find, evaluate, create, and communicate information, requiring cognitive and technical skills.

Digital literacy expands the scope of traditional literacy by including skills such as:

  • interacting with varying technology devices,
  • using digital applications,
  • digital production,
  • critical consumption of media and websites,
  • courseware, or
  • cloud computing.

But what does digital literacy look like in rural areas?

Digital Literacy’s Rural-Urban Divide

The gap between people who have access to broadband services (and know how to use them) and those who don’t is referred to as the “digital divide.”

Many factors contribute to this digital divide, including age, socioeconomic status, race, and living conditions, such as rural and urban community living. In addition, the current landscape of broadband infrastructure – who has Internet access and how they get it – influences technology literacy.

As broadband infrastructure is deployed across more accessible, affluent, and densely populated communities, low-income, minority, and rural communities have been neglected; their experience of low digital literacy contributes to this digital divide.

Of the 25 million Americans without broadband access, 19 million live in rural areas. Survey data from the Pew Research Center reports that 58% of adults in rural areas have a high-speed broadband connection at home, as opposed to 67% in urban areas and 70% in suburban areas.

The COVID-19 pandemic has exacerbated this rural-urban digital divide and made Americans more aware of the importance of digital literacy for daily living. 

Telehealth, for example, has drastically expanded under the COVID-19 pandemic. Where possible, more providers now rely on technology to assist rural residents with health concerns, prescriptions, and treatments.

With this digital gap potentially holding back rural areas, what can our communities do to help bridge the divide?

Digital Literacy Skills Teaching

Just like traditional literacy, we can teach digital literacy. A number of initiatives are already in place that work to improve technology literacy. Some of these efforts target rural communities to help close the rural-urban divide.

Here are a few examples of these technology literacy programs:

Schools are critical players in the advancement of digital literacy. The federal E-Rate program has encouraged broadband deployment to rural schools and libraries. As schools and libraries integrate these digital tools into their curriculums, users are more likely to develop digital literacy skills.

The U.S Department of Education has many digital literacy initiatives, including a program focused on teaching adults how to use digital tools for problem-solving.

The private business Techboomer is a free educational website that teaches older adults and other inexperienced Internet users basic computer skills to help improve their quality of life. In addition to many online classes, they assembled a list of the 31 Best Digital Literacy Organizations; each includes a link to the organization’s webpage, a short description of its background, and its primary goal.

DigitalLead is working to increase digital skills programming and access to technology in rural communities, specifically in rural libraries. Libraries apply for the program that provides hardware and digital skills training and resources, helping rural populations reap the benefits of broadband internet connectivity.

The Rural LISC Digital Navigators program is increasing digital literacy for all rural residents by connecting residents to discounted or subsidized Internet service plans. Rural LISC is also pursuing strategies to increase internet adoption, including:

  • affordable housing communities that work to deploy low-cost or free connectivity in common areas and residential units, and 
  • increasing the availability of public-access WiFi networks by engaging small businesses.

Let’s also look at the people and organizations most impacted by technology literacy in rural areas.

Who Will Benefit from Improved Digital Literacy?

From the self-checkout line to online banking to vetting which recipe you want to use at home, digital literacy is becoming entwined in day-to-day American life and will become even more critical as technology continues to advance.

Teaching and learning digital literacy skills is as relevant now as it ever has been, especially as we seek to reduce the current digital divide.

Rural residents can benefit from improved digital literacy in many ways. Let’s look at a few of them.

Students in rural education systems can benefit from digital literacy programs and programs that integrate technology into the classroom. Education technology connects rural students with resources outside of their immediate learning environment. 

For example, rural schools may not offer Advanced Placement courses which prepare students for college, but with the right technology available, students can virtually participate in those courses. 

Furthermore, more colleges offer education virtually, and the Online Learning Consortium reports that one in four students is taking courses online.

Improved digital literacy will empower elderly residents of rural areas to access online community resources and simple tools like grocery shopping and bill pay. In addition, there are efforts to connect elderly rural residents to telehealth resources to cut their cost of care and improve relationships with primary care physicians. 

Rural immigrants can access cultural community resources and second-language training tools. Furthermore, the internet is a valuable tool for immigrants who use it to communicate with community members in their nation of origin.

From a workforce development perspective, closing the gap in digital literacy is critical to ensuring individuals can participate in an increasingly digital economy. Job seekers use the internet for job searches, communication with potential employers, and training.

Tribal Lands are characterized by rural and remote locations, and residents on Tribal Lands have some of the lowest rates of broadband access; this makes the need to close this gap even more significant.

For Indigenous people, the internet is a tool for cultural survival and a hub for languages and traditions. Those who have access to the Internet can virtually learn traditional skills, find role models, create community, obtain an education, access healthcare, and more.

Knowing all this, you might wonder what’s next for rural digital literacy.

Closing the Rural-Urban Digital Divide

In this modern era, digital literacy is increasingly necessary, with technology woven into daily life. Closing the urban-rural divide will benefit not only our nation as a whole but also specific rural residents, including students, elderly individuals, immigrants, and Tribal Land residents. 

As we move into this new digital age, conversations about the impact of programs closing the urban-rural digital literacy divide will help communities understand what it takes to build successful programs and potential program pitfalls. 

We want to know: what are your experiences with current solutions, resources, and programs for digital literacy? You’re invited to share your personal experiences by commenting here or visiting us on Twitter (@RuralRISE).