Two of the nation's most powerful health officials are betting that artificial intelligence will help solve rural America's healthcare crisis, even as the rural patients those programs are meant to serve remain deeply skeptical.
Health Secretary Robert F. Kennedy Jr. told a Senate panel that AI nurses could provide "concierge care" to rural patients. Mehmet Oz, who leads the Centers for Medicare & Medicaid Services, has said "the best way to help some of these communities is going to be AI-based avatars" connecting rural patients to mental health services. Many state health leaders are using portions of the $50 billion federal Rural Health Transformation Program to expand AI among rural health organizations.
But evidence that AI improves rural care is thin. A recent academic paper found only 26 peer-reviewed studies about AI in rural healthcare published from 2010 through April 2025, and few analyzed implementation or outcomes. A separate report from ARISE, a Stanford- and Harvard-led evaluation group, found AI tools are being adopted despite being "poorly evaluated" and showing less evidence of working in real-world settings.
Rural patients voice doubts
In Hot Springs, South Dakota, a city of about 3,400 at the southern end of the Black Hills, residents interviewed by KFF Health News said the biggest problems in rural healthcare are cost and long waits caused by staffing shortages. Several said they don't want AI involved in their medical care.
"I get artificial intelligence for certain things, but for personal healthcare - no," said Tara Haffner, standing outside the American Legion. She said she worries about AI making mistakes and wants healthcare to stay between her and her doctor.
Roy Ehlers, another Hot Springs resident, said he doesn't trust AI in healthcare or anywhere else. "I'm old-fashioned. I don't believe in it. Technology is not my forte," he said.
Not everyone shares that view. Phillip Mues, who oversees technology at Cherry County Hospital and Clinic in rural Valentine, Nebraska, said AI scribes that record appointments and generate visit notes have helped reduce clinician burnout. "It won't replace people, but I think it will help in rural communities," he said.
Mues acknowledged AI can't fix every challenge. Rural hospitals at risk of closing or cutting services probably can't use AI to save enough money to prevent those outcomes, he said.
States plan bold experiments
Despite the lack of evidence, some states are pursuing ambitious AI projects. Utah officials said they are interested in funding AI-powered prescription refill requests. Mississippi wants predictive AI algorithms to "guide" emergency medics with triage, routing, and treatment decisions. North Dakota's plans mention AI to "detect early signs of chronic disease and behavioral health conditions."
Other states are focusing on back-office automation. A KFF Health News review of state plans shows interest in using AI for medical charting, coding, referrals, and prior authorization requests. Washington discussed tools that "identify and recover" money it's owed. Kentucky will explore AI chatbots to "deliver personalized nudges and education" through health coaching and gamified incentives.
Qian Huang, an assistant professor at the Center for Rural Health and Research at East Tennessee State University, said AI tools are usually tested at large academic hospitals and trained on urban patient data. Rural patients may have different health issues and obstacles, such as lack of transportation. Rural facilities may also lack the hardware, IT staff, or high-speed internet needed to run AI tools.
"In rural communities, trust and a personal relationship is essential," she said.
Hot Springs resident Stephanie Keller wears a smartwatch to track her fitness but has no interest in an AI chatbot using her data to encourage health goals. "I don't have the time to chat with AI every day. I mean, are you kidding me? I don't want to spend my time on a cellphone," she said.
Tracking results is uneven
The Rural Health Transformation Program was created last summer by congressional Republicans as a last-minute addition to the One Big Beautiful Bill Act. The funding was meant to offset anticipated harm to rural communities from the law, which is expected to reduce Medicaid spending by more than $900 billion over a decade.
Jordan Everson, an assistant professor at Georgetown University's Department of Family Medicine, said both urban and rural health facilities are rushing to use AI. "The risk of signing contracts that rural healthcare organizations come to regret is pretty high," said Everson, who previously worked in the IT office at the U.S. Department of Health and Human Services.
CMS spokesperson Timothy Foster said the agency doesn't have AI-specific reporting requirements but is working on a form for states to report overall progress and outcomes. Many state applications to the rural health program mention tracking only AI adoption metrics, not what happens after facilities deploy the technology.
Some states are requiring more. Connecticut will track how often AI-powered patient monitoring devices trigger accurate alerts. Texas will require organizations to track cost savings. Wisconsin lists "patient outcomes" and "productivity and efficiencies" as possible metrics.
Abraham Pritzker, who works at Julota, a company that helps health organizations track data, said states should measure whether the tech reduces falls, 911 calls, or hospital admissions. Huang said it's also important to ask clinicians and patients about their experiences using AI, then share those results broadly.
"We do not have a lot of resources to waste on tools that don't work in rural areas," she said.
Why this matters for healthcare professionals
Clinicians and administrators in rural settings should treat AI vendors' claims with caution. The technology may reduce documentation burden - AI scribes appear to help in some facilities - but the evidence base for diagnostic, triage, and monitoring tools in rural settings is nearly nonexistent. Before signing contracts, ask what outcomes will be tracked, who audits the results, and whether the tool was tested on patients like yours. Professionals seeking to understand the broader applications of AI for Healthcare or how public agencies are approaching these tools can review the AI for Government resources available through Complete AI Training.
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