Rural voters across the country are venting hard about grocery bills, gas prices and health-care costs, but that frustration hasn't translated into a wholesale break from President Trump or the Republican Party. A new survey of more than 2,000 rural registered voters finds broadly negative views of the economy paired with roughly 50 percent approval for the president's overall job performance heading into the midterms.
A Grim Read on the Cost of Living
The survey, conducted by the Associated Press and KFF from Aug. 12-24, 2026, polled 2,241 U.S. adults registered to vote in rural areas, according to kff.org. About three-quarters of respondents now rate the cost of living in their community as only fair or poor, a 25-percentage-point jump from a similar survey in 2017. Groceries, gas and health care top the list of pain points, with two-thirds of rural voters saying they're at least somewhat worried about affording health care — on par with worries about gas and higher than concerns about food, utilities or housing costs, the same source reports.
Rural American voters believe the economy is worse off now than when Trump returned to office, and about half say things have gotten worse under his watch, according to the The Independent. Rural Americans have consistently lower wages than suburban and metro residents, a structural reality that helps explain why cost-of-living complaints run so deep even in a region that leans heavily Republican.
Health Care Emerges as a Flashpoint
More than half of rural voters — 54 percent — disapprove of Trump's handling of health care, and 41 percent say administration policies have had a negative impact on their own health-care costs, compared with just 17 percent who say the impact has been positive, per the same kff.org report. Nine in ten rural voters consider health-care costs extremely or very important for candidates to discuss this fall, and 92 percent say Medicaid is important to people in their local community, with about half reporting a personal or family connection to the program.
That anxiety comes as the administration's signature tax breaks and spending cuts law is expected to reduce federal Medicaid spending by roughly $900 billion over a decade. The same law created the $50 billion Rural Health Transformation Program, but more than eight in 10 rural voters say they've heard little or nothing about it, and about six in 10 say they've heard nothing at all, the Independent notes. In Damariscotta, Maine, the local hospital announced it would soon close its labor and delivery center — a concrete example of the kind of rural health-care strain voters are describing in the poll.
Voters Weigh In
Ed Westrick, a 59-year-old technical trainer in the electronics industry who lives in rural Texas, rated Trump's job performance as mediocre and middle-of-the-road, and said he remains concerned about the cost of living, according to the Pioneer Press. Brittainy Sosebee, a 37-year-old independent voter in St. Johns, Michigan, voted for Trump in 2016, then for Joe Biden in 2020, sat out 2024, and told the paper she's still unsure whether she'll vote in Michigan's fall election.
Nate Lawrence, a Republican and middle-school teacher in Ohio, did not vote in 2024 and says he remains undecided in Ohio's competitive Senate race — one of several closely watched contests this fall, alongside races in Michigan and Maine.
Partisan Splits Persist
Trump's overall approval among rural voters stood at 48 percent, down from 56 percent in earlier KFF-Washington Post polling, while only about 40 percent approve of his handling of the economy specifically, the Independent reports. About six in 10 rural Republicans say Trump has improved the national economy, compared with fewer than two in 10 independents and fewer than one in 10 Democrats. Even among Republicans, the enthusiasm is limited: only 45 percent say Trump has made their local economy better off, and about a quarter say there are fewer good-paying jobs where they live than five years ago.
Rural voters still trust the GOP over Democrats to handle both the broader cost of living (40 percent to 25 percent) and health-care costs specifically (33 percent to 28 percent), though 27 percent say they trust neither party, per kff.org. Rural Republicans trust their own party on health costs at about 60 percent, while roughly 80 percent of rural Democrats trust theirs. Rural voters also rank pocketbook concerns and fraud in government programs above gun policy and abortion, and rate Trump's handling of the Iran war similarly to his handling of the economy.
What It Could Mean for November
Rural Americans skew Republican and remain more so than the electorate nationally, where party identification is roughly evenly split. Still, the survey suggests that dissatisfaction could pose a challenge for Trump and the Republican Party in November, particularly if disaffected Republicans stay engaged: among the roughly quarter of rural Republicans who disapprove of Trump's handling of the economy, 59 percent say they're absolutely certain to vote, a smaller share than Republicans overall. Rural Democrats report even higher turnout intent, at 80 percent absolutely certain to vote compared with 74 percent of rural Republicans.
Tim Slack said many people connect the cost-of-living crisis to Trump administration policy choices, including the war in Iran, tariffs and trade wars, according to the Pioneer Press. On perceptions of respect, 48 percent of rural voters say the GOP respects rural voters, 45 percent say the same of Trump personally, and just 37 percent say so of the Democratic Party — numbers that suggest goodwill toward Republicans remains intact even as economic grievances mount. The poll, conducted in collaboration by the Associated Press and KFF Health News using a probability-based SSRS opinion panel, carried a margin of sampling error of plus or minus 3 percentage points.
