At HAMC, a daylit central “main street” connects major departments while welcoming patients and visitors with intuitive wayfinding and gathering spaces, including a community café.
Rural health is the backbone of care for millions of Americans, yet these systems face persistent challenges that keep them operating under strain. From geographic and funding limitations to technology and training shortages, rural providers routinely encounter hurdles that larger systems rarely face — especially in critical access and rural emergency hospitals and state hospitals in rural communities.
For years, rural healthcare has contended with “medical deserts” and rising demand for mental and behavioral health services, making it even harder to recruit specialists and retain staff. In this environment, where burnout brews, architects are helping to shift the perspective. Today, architects are partnering with health systems to strengthen the rural workforce — through in-house training with collegiate partnerships, multi-faceted innovation and multi-use community hubs designed to care for both patients and providers.
The rural workforce challenge
It’s widely known that approximately two-thirds of the nation’s healthcare shortage areas are within rural regions. According to insights from National Academy for State Health Policy’s 2025 Annual Conference (Hodges, 2025) — focused on improving access to care in rural communities across North Dakota, Washington and West Virginia — North Dakota described the absence of neonatal intensive care units in rural areas, contributing to what is referred to as “maternity care deserts.” Washington spoke of the challenges in providing behavioral health services and the solution of community care hubs. Although all three states emphasized the importance of broadband and telehealth in expanding access to services, workforce shortages have been an ongoing hurdle impacting outcomes.
Rural vs. urban outcomes
Beyond the stark disparities between rural and urban health outcomes for patients, rural health systems repeatedly note higher rates of burnout for providers. This makes sense, considering the typical rural health system may serve anywhere from five to 15 communities across multiple counties, often spanning a 30- to 90-mile radius.
Within the web of rural healthcare, limited access, workforce shortages, financial strain and long travel distances don’t stay at the system level. These challenges impact care delivery, staff wellness and the overall health of communities. In many cases, patients wait longer to seek help or preventive care, which often leads to advanced conditions and higher rates of chronic disease. For those required to travel the distance for basic services, missed appointments become the norm — interrupted by weather, transportation, time off from work and childcare. For those seeking mental and behavioral health, access to specialized or immediate services is minimal and sometimes avoided due to lack of anonymity. Not only does this put a higher strain on emergency departments, but it also increases the rural population’s rates of depression, anxiety and substance abuse.
Empowering patient, staff & community well-being
While architecture has always played a pivotal role in rural healthcare environments, its more recent role in workforce training, recruitment and retention is its biggest flex. Healthcare design is no longer entirely focused on patient care, which left staff and provider care as an afterthought. Exceptionally designed rural healthcare facilities empowers the well-being of its providers, patients and overall community, ultimately reinforcing the workforce by reinforcing healthy population growth.
How do we build workforce resilience in rural healthcare? Start with an environment that prioritizes staff well-being, creating spaces capable of adapting to evolving needs, respite/meditation spaces that demonstrate care for the mental health of all occupants, and advanced training spaces that partner with collegiate programs to unite simulation and ongoing education. In high-stress healthcare environments, prioritize nature and natural light through daylight-centric, biophilic design that includes direct access to outdoor spaces and walking paths.
A smarter system
Provider respite is no longer an optional add-on. Healthcare systems know essential workers need essential care, including a wide range of calming work and break areas. Today, “huddle” spaces encourage informal team collaboration, modular planning accommodates changes in staffing and workflow and quiet zones integrate acoustic detailing and technology that supports auditory privacy. Beyond respite, advanced instrumentation and software are critical in recruiting and retaining existing staff while helping to reduce automated, day-to-day tasks.
At the site of the new North Dakota State Hospital in Jamestown, North Dakota (pop. 15,849), the design pushes its capabilities beyond clinical spaces. Intentionally designed to advance behavioral health statewide, the 300,000-square-foot facility will bring all services together under one rural roof — delivering cutting-edge inpatient and community-based care, as well as dynamic educational spaces that foster university partnerships and expand workforce opportunities.
The hospital is slated to include an education wing, medication room simulation, mock-patient room simulation areas, an adaptable classroom, telehealth/remote support technology and respite rooms to help reduce stress while fostering a culture of supportive learning. The overall concept gives providers and emerging healthcare professionals access to ongoing education, self-care and recovery — all key to staff retention and recruitment.
Heart of healthcare
Right now, architects across the country are rebuilding communities by rebuilding healthcare facilities that operate more like all-in-one, small-town community centers. These new healthcare hubs don’t just fast-track connections via community cafés and fitness centers, they provide specialized care within a more comfortable, “close to home” experience.
At the new Heart of America Medical Center in Rugby, North Dakota (pop. 2,383), its 77,000-square-foot critical access hospital serves more than 13,000 people within a 50-mile radius. The design merges a welcoming community center and modern healthcare delivery model, focusing its footprint on a future of more outpatient versus inpatient services.
HAMC’s hospital, clinic and care center redefine rural healthcare and reconnect providers to community through a daylit “main street” corridor, community café and 24/7 wellness center. This multi-tasking, non-sterile facility is designed to attract top-tier providers and keep patients close to home, offering an expanded surgical department, cancer center, a Living Center residential-style swing bed department, therapy department and back-of-house staff respite areas.
The center’s corridor simplifies circulation, centralizes community gathering zones and strategically positions departments for cross-collaboration. Strengthening workforce recruitment and retention were top-of-mind, forging an efficient design that streamlines pathways between emergency services, acute care, radiology and the Living Center.
Future of rural healthcare design
Looking forward, the evolution of rural healthcare design must continue to prioritize the needs of its workforce while also supporting the vitality of entire communities. Rural healthcare hubs are more than places of healing; they are anchors that help reinforce population growth and stability, ensuring small towns remain vibrant and viable. Ongoing investment in staff-centered, community-focused environments is essential for the sustainability of rural critical access and state hospitals, as well as the many towns they serve. By recognizing the value of strong healthcare teams and the thoughtfully designed spaces that support them, we help safeguard the future of rural communities — so that no small town is left behind.
Todd Medd, AIA, is a healthcare practice studio leader at JLG Architects.
HAMC photos by Chad Ziemendorf.
ND State Hospital renderings by JLG Architects.
