Rural definitions are used in a variety of formal settings, including federal and state statutes and policies. They are frequently used to focus attention and direct resources to underserved populations to help achieve goals of access to essential services, health equity, and reduction of disparities. Although there are a number of these definitions utilized by policies and programs, most rural definitions rely on a combination of population density and economic integration with (or proximity to) urbanized areas. But several important factors have changed during the last 10-20 years leading to discussions among policymakers and investigators about the validity of historic methods for defining rural areas.

The definition of rural areas should be data-driven, built on a conceptual framework that is relevant to their purpose, robust over time but malleable as required, and exhibit face validity. A number of options to consider for adjustment of current or development of new definitions are made. These include enhancement of current frameworks, making greater use the variation already available in current definitions, utilization of additional data resources, and adjustment of census methods.