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Rural America has a healthcare crisis hiding in plain sight. Hospitals are closing. Nurses are retiring faster than they can be replaced. And the students most likely to stay and serve their communities — kids growing up in small towns across Indiana, Texas, Delaware and dozens of states in between — often graduate high school with no clear path into the healthcare careers that desperately need them.

Now there’s a once-in-a-generation designed to change that. But most educators, workforce leaders and even some state policymakers haven’t heard of it yet.

The Rural Health Transformation Program represents a $50 billion federal commitment between 2026 and 2030, administered through the Centers for Medicare and Medicaid Services and flowing to states based on rural population and approved transformation plans. Every participating state will receive roughly $1 billion or more to redesign rural healthcare delivery, stabilize rural hospitals and build sustainable health systems. Education and workforce development are explicitly named as core investment priorities.

The question isn’t whether this money will be spent. It’s whether states will spend it wisely enough to actually build the talent pipelines rural communities need — or whether it will flow almost entirely to system stabilization, leaving the workforce crisis unaddressed at its root.

We think states should dedicate a meaningful share of this funding to catalyze cross-sector partnerships that build the healthcare workforce starting in high school. Here’s why.

Nursing is one of the most powerful engines of economic mobility in America. 

The Wall Street Journal on nursing’s standing as an exceptional pathway — accessible without elite credentials, leading to stable middle-class wages and open to students from all backgrounds. Burning Glass confirms the nursing degree is among the least likely to be underemployed of any college degree program. For rural students — who are disproportionately low-income, first-generation and from communities of color — a clear, supported pathway into nursing isn’t just career preparation. It’s economic transformation and community revitalization.

But pathways don’t build themselves. They require high schools, community colleges and universities, and hospitals to do something most of them have never done together: align curriculum, clinical placements, financial aid and hiring pipelines into a coherent system.

Models like in Indiana show this is possible. There, high schools, colleges and regional health systems have built integrated pathways that braid together K-12 funding, registered apprenticeship dollars, Pell grants and direct employer investment to move students from healthcare CTE coursework into Licensed Practical Nurse credentials — and ultimately toward RN roles. 

Students earn credentials, communities get nurses, and hospitals get a workforce they helped train. Similarly, the Rodel Foundation in Delaware just released a confirming that these approaches work. The study finds that 81% of high school graduates from healthcare pathways are either enrolled in postsecondary education or employed in healthcare within 18 months of graduation, demonstrating a clear connection between high school pathways and in-demand careers. That’s what a system designed to work looks like.

Bloomberg Philanthropies’ early investments in have generated important proof points — demonstrating how partnerships between schools and hospitals can be structured, funded and sustained over time. These efforts have shown how to align curriculum with real workforce needs, embed clinical experiences into high school programs and create clear pathways into postsecondary education and healthcare careers. As such, they offer a scalable model for other states and systems. The critical lesson for rural contexts, though, is that place matters. Rural communities can’t typically support a standalone healthcare high school. What they can support — and what this new federal funding should support — are regional pathway models that serve students across multiple school districts, built around a hospital or health system as the anchor employer and clinical training partner.

This is exactly the kind of cross-sector, multi-institution collaboration the new federal program is  designed to enable. It explicitly prioritizes regional partnerships across healthcare providers, workforce boards and educational institutions. It allows braiding with federal and state workforce dollars. And states could create a public-private innovation model that attracts philanthropic and employer investment alongside federal resources — multiplying the impact of every federal dollar.

The infrastructure for this already exists in many states, with the vast majority prioritizing high-quality career and technical education and supporting statewide college promise programs or workforce-focused scholarships. What’s been missing is a funding mechanism substantial enough to make cross-sector partnership worth the coordination cost — and a policy signal from state leaders that building the healthcare workforce of the future is as important as stabilizing the hospitals of today.

The new federal program creates the opening, but state leaders will determine whether it becomes a short-term stabilization fund or a long-term workforce strategy. States that move quickly to align their education, workforce and health agencies, and invest in regional pathway models that move rural students into nursing and allied health careers, will be better positioned to strengthen both hospitals and communities for years to come.

The $50 billion is already arriving, and states are starting to roll these resources out into communities. The only question is whether it builds something that lasts.

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