This month, a North Dakota network of rural hospitals enters its second year of trying to make local operations more efficient, so they can keep the doors open for patients and keep their local communities thriving.

The Rough Rider High-Value Network was announced in October 2023. It is made up of 23 independent, critical access hospitals in smaller towns and cities across the state. Leaders from the facilities share best practices and ways to keep costs lower.

Kylie Nissen, executive director of the North Dakota Rural Health Association, said she is encouraged by the effort, knowing the long-standing struggles hospitals and clinics in these areas have faced.

"It's not only closures that we're concerned about, it's rural community members (who) don't want to see their hospital bought out by a large system, too," Nissen observed. "Because then, the decision-making and the care for their local community just isn't there."

Since it began, the collaborative has secured at least two desirable contracts with commercial health insurers, benefiting all member hospitals. In its August forecast, Becker's Hospital Review reported five North Dakota hospitals were at immediate risk of closing within the next two to three years.

Nissen pointed out the ripple effect of keeping the hospitals independent and running efficiently, while improving patient care, can be felt across an entire community.

"Health care is huge when it comes to economics," Nissen stressed.

She added a healthier population, that does not have to travel as far for appointments or other care needs, results in a stronger workforce. She acknowledged they are still navigating challenges, like reducing maternal care "deserts," noting federal grants are competitive. The state of North Dakota chipped in $3.5 million to help get the Rough Rider Network started.


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A new program aims to ensure rural Mainers can take full advantage of expanding high-speed internet service.

Grant applications open this week for nonprofits, tribal entities and others to train underserved communities in technical skills and online safety.

Maggie Drummond-Bahl, senior director of digital equity and partnerships for the Maine Connectivity Authority, said the funds are directed at those most affected by the so-called 'digital divide,' including older Mainers, veterans and people with disabilities.

"We know the needs are pretty significant," Drummond-Bahl acknowledged. "This is really a down payment in starting to address some of those needs."

Drummond-Bahl pointed out the goal is to fund the agencies and organizations already connected and working to improve their communities. Maine has been awarded nearly $6 million to implement its Digital Equity Plan, which includes expanding broadband service and ensuring its affordability. Roughly 5% of rural areas in Maine still struggle with slow or unreliable internet.

The Maine Connectivity Authority aims to secure at least 25,000 donated devices for refurbishment, including laptops and tablets. Part of the new funding will be used to promote a statewide campaign to encourage businesses and organizations to contribute. Drummond-Bahl noted previous surveys revealed many Mainers are not confident in their digital skills but can learn to better use these devices in a familiar setting.

"If you're an older adult and you are already connected to your local Area Agency on Aging or another partner like that, it is a real benefit to have a digital skills training with an organization you're comfortable and already connected to," Drummond-Bahl emphasized.

Drummond-Bahl explained the campaign to recycle and reuse devices feeds into the state's environmental and climate goals to reduce waste and greenhouse gas emissions. She added funds will also help develop a new online tool to help people locate community resources and the digital skills training they need.


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By the end of June, students in seven very remote rural New Mexico school districts will get access to high-speed home internet through a state grant program.

The "Student Connect" program was established by the legislature in 2021.

Mike Curtis, public relations coordinator for New Mexico's Office of Broadband Access and Expansion, said the disparity in students with and without internet to complete homework was a source of frustration during the pandemic.

"A lot of kids who live in rural areas, while they get internet at schools, once they get home or in other parts of their communities, there's no internet," Curtis explained.

Curtis pointed out statewide, $70 million has been designated to expand broadband in unserved and underserved areas and all projects are scheduled for completion by June 30.

Curtis noted $56 million has been awarded through the Connect New Mexico Fund so far and the recent award is from a subprogram created specifically to help students. He emphasized the new broadband infrastructure will connect more than 4,600 homes, businesses, farms and other locations.

"It's an assistance program. It's not a merit program, so they're not competing with any other entities," Curtis stressed. "They apply for the money and then, within six months they'll be getting service. And they also get three years of free internet if they apply."

He said the money will go toward building towers, installing fixed wireless service and providing receivers to homes.


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Several rural communities across North Dakota are strategizing how to slow the pace of local grocery stores shutting down.

Some are making use of state grant money to aid their efforts, but challenges remain.

In North Dakota's Walsh County, the Rural Access Distribution Cooperative has been on the leading edge of establishing local grocery store co-ops, where a handful of smaller shops buy items in bulk together.

The initiative was eventually awarded a state grant to buy a bigger truck and van, making supply deliveries more manageable.

Cooperative President Alexander Bata said they continue to see progress with increased sales, and better options for area residents.

"So, there's less waste, less cost," said Bata, "and we've significantly improved the quality of food."

However, other elements of the initiative still face hurdles.

That includes utilizing food lockers, where customers can buy their food online and pick it up when they choose. But Bata said they haven't been able to make the technology work.

In 2023, the Legislature approved $1 million for interested communities to sustain grocery service in smaller towns with limited access.

The town of Milnor, with a population of around 600, was one of the early grantees - and used its money for a feasibility study.

Milnor's Community Economic Development Coordinator Carol Peterson said those findings were clear - their lone grocery store needs more storage space to stay afloat.

"It makes it very hard," said Peterson, "to order in enough product to service the community."

That limits the store from keeping prices lower.

Peterson said she worries more customers will then look at far away options, taking their tax dollars with them. While local leaders did get a read on what's needed, they haven't been able to secure additional funding for the next phase.

A key legislative sponsor of the pilot grant program says there's interest in extending it next session, but she's still gathering feedback.


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