This research will be featured in-depth at ACCT’s upcoming Leadership Congress, during a free pre-conference session titled Current Issues and Emerging Evidence in Rural Higher Education on Wednesday, October 21. Please CLICK HERE for more information and register to attend this session in Chicago.

In summer 2025, the Western Interstate Commission for Higher Education (WICHE) brought together stakeholders from Colorado, New Mexico, and Wyoming to discuss the challenges and opportunities impacting rural nursing students, institutions, and employers. The conversation made clear that advancing rural nursing requires more than expanding enrollment in nursing programs. It requires coordinated strategies that support students, expand clinical learning opportunities, invest in faculty and preceptors, and account for the realities of rural healthcare delivery.

The Main Challenges Facing Rural Nursing Education

Rural Nursing Students often face geographic and financial barriers

Rural students often travel farther for postsecondary education than students in more populated areas, especially for clinical placements, which are sometimes unavailable locally. This requires additional travel and sometimes lodging costs, adding financial burdens. Clinical requirements can also make it difficult for students to work while in school, increasing financial strain, especially for those with family or other obligations.

Roundtable participants noted that securing clinical placements is challenging for both rural and urban institutions, but more so in rural areas. These challenges often stem from systemic issues like hospital budget and staffing problems, limiting clinical rotation opportunities and access to specialists. Rural hospitals often have limited services, forcing patient transfers and reducing clinical training opportunities. Most clinical slots at rural institutions are at larger urban hospitals, often more than an hour away, creating a burden for students and increasing competition among institutions for placements. Participants highlighted the administrative burden, noting that rural students often work across multiple sites, requiring extensive travel and administrative tasks that add time and cost burdens. 

One major barrier to expanding nursing program capacity is a persistent shortage of nursing faculty. Several factors contribute to this shortage. First, more than 5,000 qualified students cannot enroll in master’s and doctoral programs because of faculty shortages. This limits the future growth of the nursing educator workforce. Additionally, the median salary of an Advanced Practice Registered Nurse (APRN) is over 38% higher than that of a master’s-prepared nursing faculty. This pay disparity provides minimal incentive for nurses to transition into academia. These shortages are expected to intensify in the coming years, as more faculty are expected to retire. 

Preceptors are working nurses who care for patients and teach nursing students in clinical settings. Rural healthcare providers and the rural healthcare workforce are disproportionately affected by nursing shortages, making the preceptor shortage even more severe. In rural settings, which face greater financial and staffing challenges, nurses already juggle multiple roles and have limited capacity for teaching. A report from the National Rural Health Association (NHRA) highlights that the broad scope of practice by rural healthcare providers worsens the challenge for rural preceptors, and limited staff resources can increase preceptors' risk of burnout.

Strategies and Opportunities to Support the Rural Nursing Workforce

Addressing rural nursing workforce shortages is vital for meeting the healthcare needs of rural communities. Nurses trained locally are more likely to stay in these areas, highlighting the importance of investing in rural clinical learning and expanding promising strategies that support the development of rural-prepared nurses.

Train-in-place models allow students to complete more of their nursing education while remaining in their home communities. These approaches can reduce travel burden, help students maintain local employment and family responsibilities, and increase the likelihood that students will remain in rural communities after graduation.

Laramie County Community College’s (LCCC) asynchronous practical nursing program is an example of a learning opportunity that allows students to remain in their home community with limited in-person learning intensives. This model allows students from across Wyoming to enroll and keep working while pursuing their degree.

The University of New Mexico College of Nursing partners with six community colleges across the state, enabling students to dual enroll in an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) program. This approach is especially important for rural community colleges, as it allows students to graduate with a BSN while staying in their home communities.

Apprenticeships and other earn-and-learn models can help students gain workplace experience while earning income. These models are especially promising for rural communities because students who train locally may be more likely to stay and work locally. Rural-focused nursing apprenticeship programs, such as one at Lake Region State College in North Dakota, also offer opportunities to align education, employment, and community workforce needs.

Roundtable participants emphasized that financial supports for rural nursing students need to go beyond tuition assistance. Students may need help covering transportation, lodging, childcare, groceries, background checks, health screenings, and other costs tied to clinical training. Scholarship programs, emergency funds, transportation reimbursement, and targeted state investments can all help reduce barriers to completion.

Partnerships between nursing programs and healthcare providers are essential to expanding clinical learning opportunities. Some institutions are looking beyond traditional hospital placements by partnering with detention centers, home care providers, community clinics, foster youth clinics, and other care settings that can help students meet clinical requirements while staying closer to home. Academic-practice partnerships and Dedicated Education Units (DEUs) also offer promising models. These partnerships can improve student learning, strengthen practice readiness, and help rural providers recruit nurses who trained in their communities.

States and institutions are also exploring financial investments and incentives to recruit and retain nursing faculty and preceptors. These strategies include faculty salary investments, stipends, tax credits, preceptor grants, adjunct status for clinical partners, and expanded preceptor training academies. At the federal level, the Rural Health Transformation Program is a $50 billion investment for all states to strengthen rural health access, including through workforce development and capacity-building initiatives.

Strengthening Rural Nursing Requires a Systems Approach

Nursing workforce development is centered at the crossroads of two vital pillars in rural communities: healthcare and education, and the difficulties in strengthening the rural nursing workforce are closely linked to ongoing barriers to accessing education and healthcare. The roundtable participants underscored that strengthening the rural nursing workforce will require coordinated action across education, workforce policy, and healthcare delivery. Expanding strategies such as train-in-place and earn-and-learn models, reducing student costs, and investing in instructors and preceptors offer opportunities for education and workforce partners to work together to create pathways into rural nursing while developing the skills needed for the rural nursing workforce.

About this Work

The Western Interstate Commission for Higher Education (WICHE) is a regional interstate higher education compact of 15 Western states and the U.S. Pacific Territories and Freely Associated States. Since 1953, WICHE has focused on its mission of expanding educational access and excellence for all residents of the West. By promoting innovation, cooperation, resource sharing, and sound public policy, WICHE strengthens higher education’s contributions to the region’s social, economic, and civic life. Visit wiche.edu. 

This blog post is an excerpt from a June 2026 WICHE Insights, Nursing in the Rural West: Challenges and Opportunities for Supporting Rural Students and Communities. Click here to learn more about WICHE’s work supporting rural nursing in the West. 

WICHE is a member of the National Rural Higher Education Research Center led by MDRC. The research reported here was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant R305C240065 to MDRC. The opinions expressed are those of the authors and do not represent the views of the Institute or the U.S. Department of Education.