Efforts to support rural communities are often framed through what is missing – access to providers, funding, and infrastructure. But this framing overlooks something critical: the asset-oriented work is already underway. Rural communities are innovating, adapting, and leading in ways that others could learn from and replicate.

Rural health systems are navigating real issues: workforce shortages, varying infrastructure, fragmented funding that prioritizes programs over systems, and a continued need to address the drivers of health. At the same time, they are operating with distinct strengths – deep, trust-based relationships across sectors; a reliance on shared resources and cross-boundary approaches; and a clearer throughline between community voice and decision making. These cross-sector, community-centered approaches are exactly what is needed in all communities as we think about system transformation.

As efforts such as the Rural Health Transformation Program and others move forward, there is meaningful opportunity to build on this foundation and align with local realities. This means investing in infrastructure, not just interventions; supporting sustainable coordination across public health, health care and community partners; and aligning finding with outcomes to move from short term solutions to sustained, systems level change.

In practice, this can look like:

• Service and Resource Sharing: using informal and formal sharing approaches to align and pool capacity and deliver services across jurisdictions and sectors – extended reach of resources.
• Performance Management and Quality Improvement (PM/QI): creating the infrastructure not just to do the work, but to learn from it, improve it, and demonstrate outcomes.
• Strategic Assessment and Planning: aligning partners around shared priorities grounded in community voice, and leveraging existing coalitions as a foundation for broader system alignment
• Building from Existing Infrastructure: leveraging established efforts, such as Community Health Assessment (CHA) or Community Health Improvement Plan (CHIP) coalitions and regional partnerships, as a foundation for coordination, rather than creating new, parallel structures.

Transformation doesn’t require rural communities to start from scratch: it requires recognizing and elevating strengths; investing in the systems that make those strengths scalable; aligning programs and investments with on the ground needs and realities; and leaning into shared approaches that extend capacity across boundaries. Rural communities are not waiting for transformation – they are demonstrating what transformation looks like in practice, and all communities and systems can follow their lead. 

Reena Chudgar, MPH, is the Director of Public Health Systems and Services at the Public Health Accreditation Board (PHAB) supporting implementation of the Public Health National Center for Innovations and Center for Sharing Public Health Services efforts. Reena joined PHAB/PHNCI in April 2019 and engages with health departments and communities in using innovation as a tool for transformation. Her work centers around strategy and program implementation, and is passionate about social and systems change, addressing root causes of historical and current racial and health inequities, and local and people-centered decision making. Prior to joining PHAB, Reena served as Director for Performance Improvement at the National Association of County & City Health Officials (NACCHO), where she supports health departments in fostering partnerships, cross-sector collaboration, community and strategic planning, and more. Reena received a Master of Public Health degree and a bachelor’s degree in chemistry from Emory University.