State of Employees’ Mental Health in Rural America

1. Introduction

Approximately 19.3% of the U.S. population lives in rural areas, and approximately 8.6 million of them experience mental health challenges (USDA, 2023). Mental health challenges refer to psychiatric conditions of unwanted stress, depression, and anxiety (WHO, 2025), and have been on the rise in rural U.S. over the last decade (Smith et al., 2026). Mental health issues are a bigger challenge in rural areas due to unique barriers, such as fewer primary care providers, limited psychiatric services, a shortage of health care practitioners, long travel distances, insufficient transportation, greater rates of poverty, and social culture challenges, including the stigma of mental health treatment among rural communities (Mental Health America, 2026).

Although the Healthy People 2030, a national framework that guides programs and policies to improve health outcomes of all people in the U.S., has prioritized the importance of employee health and well-being and offers services to the U.S. workforce (Pronk et al., 2021; U.S. Department of Health and Human Services, 2025), access to these services is not equal for all employees. Employees in rural areas are more likely to experience delayed or missed care, which can contribute to poor mental well-being. As employees spend most of their time at work, the workplace can shape the mental well-being of employees (Sampaio et al., 2022). Rural employees often work longer hours, have low wage rates, low job mobility, and face increased occupational demands, all of which can negatively affect mental health (Schroeder et al., 2020).

In this study, we assessed mental health issues among rural employees using self-reported data from a cross-sectional survey. We used six items to measure mental health issues. Overall, we examined what kind of mental health issues are prevalent in rural areas and what kind of support employees are getting from their employers. Evaluating the mental health and well-being of rural communities is important because identifying existing mental issues can help strengthen vulnerable rural communities.

2. Data

We collected cross-sectional data from rural small businesses across the U.S. Rural areas were defined using federal criteria as communities with populations of fewer than 5,000 residents (CDC, 2024), and small businesses were defined as those with fewer than 500 employees (The State of Small Business in America, 2023). Together, these definitions characterize rural small businesses. To assess mental health, we used measures of psychological distress, along with information on the kinds of support and services employees received. Data were gathered using the online Qualtrics platform. The study included 1861 employees and was conducted from June to November 2024. Study procedures were conducted in compliance with the Purdue University Review Board. The sample was from small businesses operating in rural areas across different sectors.

3. Results

3.1 Demographic characteristics

Table 1 presents a summary of socio-demographic characteristics and employer support in the sample. The average age of employees was 46 years. Approximately 30.6% of employees were male, 60.1% were married, and 86.2% identified as White. The average household size of employees was 2.9. A total of 81.6% employees reported that they received employer support for job skills development.

Table 1

Socio-demographic characteristics

Source: Authors’ own calculation from survey data

3.2. Mental health status of employees

To measure employees’ mental health in the past 30 days, we asked six questions regarding how often they felt nervous, hopeless, restless, depressed, worthless, and that everything was an effort. Responses were “all the time”, “some of the time”, and “none of the time” as shown in Figure 1. Overall, a large share of respondents reported experiencing feelings of nervousness (57.3%), restlessness (50.6%), and that everything was an effort (49.3%) “some of the time”. In contrast, a greater proportion indicated experiencing feelings of worthlessness (61.8%), depression (61.6%), or hopelessness (52.9%) “none of the time”.

Figure 1

Survey responses for psychological distress

3.3 Workplace support

3.3.1 Employer support

As employer support can reduce job-related stress (Raykov, 2014), we asked respondents whether they receive support or help from managers and colleagues to perform their jobs effectively. The majority of employees (81.6%) reported feeling supported by their managers and colleagues in doing their jobs well, as shown in Figure 2, indicating that employees in our sample have generally positive and supportive social experiences.

Figure 2

3.3.2 Status on healthcare and employee assistance program from employers

We examined employer-provided support related to healthcare and employee well-being. Specifically, we asked whether their employer offers 1) healthcare insurance, 2) an employee assistance program, and 3) any form of employee wellness training. Each question required a “Yes” or “No” response. A total of 76.7% of employees received employee health insurance, 53.3% reported access to an employee assistance program, and 44.5% received employee wellness training, as shown in Figure 3.

Figure 3

Assistance from employers

4. Conclusions

This study examines the mental well-being and working conditions of small-business employees in rural U.S. Using an online survey, our descriptive analysis shows that most employees report nervousness, restlessness, and feeling that everything is an effort. In contrast, hopelessness, depression, and feelings of worthlessness are not the main concern. At least 50% of employees receive some form of support from their employers. In designing the program for small businesses, policymakers may focus on the program reducing nervousness, restlessness, and the feeling that everything is an effort. The findings from this study can be useful to policymakers, small business owners, and employees to develop targeted strategies that meet the unique needs of rural small business employees.

References

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