Grow Your Own Workforce: How Rural Providers Build Sustainable Talent Pipelines

Rural communities across the West are confronting a shared challenge: persistent shortages of nurses, physicians, behavioral health professionals, and allied health workers. Long travel distances, thin operating margins, and competition from urban systems make recruitment difficult and retention even harder. In response, states participating in the Rural Health Transformation Program (RHTP) are converging on a powerful strategy—grow your own workforce pipelines that develop local talent, support them through training, and anchor careers in the communities they already call home.

Across RHTP applications submitted to Centers for Medicare & Medicaid Services, a clear pattern emerges: sustainable rural health care depends on community-rooted workforce development paired with modern training models, incentives, and career pathways.

Why “Grow Your Own” Works in Rural America

RHTP applications repeatedly note that clinicians who come from rural communities—or train extensively within them—are far more likely to stay long term. Alaska’s proposal emphasizes regionally designed, community-led systems that reflect local culture and geography, recognizing that workforce solutions must be flexible enough to fit frontier realities .

Similarly, South Dakota identifies workforce shortages and clinician burnout as core threats to access, calling for investments that reduce administrative burden while advancing rural workforce pipelines . The takeaway is consistent: retention begins before recruitment, by building interest and opportunity locally.

Building the Pipeline Early: Education and Exposure

Many states are pushing workforce development upstream—well before licensure—by creating exposure pathways for rural students:

• K–12 and postsecondary pathways that introduce health careers early and align coursework with local employer needs, highlighted in New Mexico’s “Rooted in New Mexico” initiative .
• Rural rotations and residencies that allow trainees to experience rural practice with strong preceptor support, a key focus in Idaho’s plan to sustain its rural workforce through training and retention .
• Community health worker and extender models that broaden the care team and create entry points for local residents, seen across Oregon and Washington’s applications .

These approaches recognize that rural workforce development is not a single program, but a continuum from student to seasoned professional.

Incentives That Keep Talent Local

Financial and professional incentives appear throughout RHTP submissions, but with a notable shift: states are pairing incentives with community integration rather than relying on short-term fixes.

Nevada’s Workforce Recruitment & Rural Access Program combines recruitment incentives with system-level support so clinicians are not isolated once they arrive . Kansas and North Dakota both emphasize aligning incentives with broader system sustainability, ensuring that workforce investments reinforce local hospitals and clinics instead of cycling staff through temporary placements .

Training for the Care Models of Tomorrow

Another unifying theme is training aligned to new care models. California, Colorado, and Texas all connect workforce strategies to hub-and-spoke networks, telehealth, and team-based care—preparing clinicians to practice at the top of their license while leveraging technology .

This alignment matters. As Wyoming’s application notes, building a durable rural workforce pipeline requires not only more workers, but workers trained for right-sized, coordinated rural care models .

What Rural Providers Can Learn

From these RHTP applications, several best practices stand out for rural providers and systems:

1. Start local and early: Partner with schools, colleges, and community organizations to introduce health careers before students leave the region.
2. Train where you want people to stay: Rural rotations, residencies, and apprenticeships build confidence and community connection.
3. Support the whole clinician: Reduce burnout through team-based care, technology support, and administrative relief.
4. Tie workforce to system strategy: Align training and recruitment with new care models and long-term sustainability goals.

A Workforce Strategy Built to Last

The RHTP applications make one thing clear: rural America is not waiting for outside solutions. States and providers are designing homegrown workforce pipelines that reflect local needs, cultures, and realities. By growing their own talent—and supporting that talent with modern training, incentives, and care models—rural communities are laying the foundation for a resilient health system that can serve generations to come.

As RHTP implementation unfolds, these workforce strategies will be central to whether rural health transformation delivers on its promise—not just of better access today, but of sustainable care tomorrow.