Rural Voters are More Likely to Trust Republicans than Democrats to Tackle These Issues, But Economic Dissatisfaction May Dampen Turnout among Rural Republicans, and Trump’s Health Policies Are Viewed Negatively

September 24, 2026 - Rural voters’ frustrations about the cost of living in their community are growing and appear to be chipping away at Republicans’ enthusiasm to vote as the midterm elections near, a new KFF/Associated Press (AP) Survey of Rural Voters finds.

The survey of more than 2,000 rural voters probes the views and experiences of a group who have been strong supporters of President Trump and Republicans but are feeling economically stressed and facing higher health care costs. The project includes a polling analysis from KFF, which often partners with media organizations on surveys, and reporting from journalists at the AP and KFF Health News. Additional stories drawing on the poll findings and rural voters’ perspectives will come out in the coming weeks.

The survey’s key takeaways include:

• Cost of living concerns are increasing, and Republicans maintain an edge with rural voters. Rural voters overwhelmingly name the cost of living as the top issue they want candidates to talk about, and three quarters now rate the cost of living in their area as either “fair” or “poor,” a 25-percentage point increase from 2017. When it comes to household expenses, rural voters worry most about health costs and gas prices. More rural voters prefer the Republican Party than the Democratic Party to best address the cost of living (40% v. 25%), though a quarter (27%), including most independents, trust neither party.
• Economic frustration may hurt turnout among Republicans. Eight in ten rural Democrats say they’re “absolutely certain” to vote in the upcoming midterm, somewhat higher than the 74% of rural Republican voters who say so. This disparity appears to be at least partly a result of dissatisfaction with President Trump’s economic policies. Among the 27% of rural Republican voters who disapprove of President Trump’s handling of the economy, a smaller share (59%) say they are “absolutely certain” to vote.
• Views of President Trump’s health care policies skew negative. Slightly more than half (54%) of rural voters disapprove of President Trump’s handling of health care and largely view his health care policies as having negatively rather than positively impacted their health care costs, Medicaid, and the availability of care where they live. Still, the Republican Party has a narrow advantage over the Democratic Party in rural voters’ trust to handle the cost of health care (33% vs. 28%), though three in ten (29%) trust neither party to deal with the issue.
• Medicaid viewed as important, but messaging about fraud resonates with Republicans. The overwhelming majority (92%) of rural voters say Medicaid is important for people in their local community, and about half (49%) have had a personal or family connection to the program at some point in their lives. But messaging about fraud may appeal to rural Republican voters, as fraud in government programs is their top issue for candidates to talk about.

The survey also examines rural voters’ views about job opportunities and safety in their community, who they trust to handle key economic and health care issues, and health care access issues in their communities, including provider and hospital shortages.

METHODOLOGY 

Designed and analyzed by public opinion researchers at KFF and the Associated Press, this survey was conducted August 12-24, 2026, online and by telephone among a nationally representative sample of 2,241 U.S. adults registered to vote in rural areas of the country. The margin of sampling error is plus or minus three percentage points for the full sample of rural voters. For results based on other subgroups, the margin of sampling error may be higher. The survey was conducted in English and Spanish.

About KFF

KFF is the independent source for health policy research, polling, and journalism. Its mission is to serve as a nonpartisan source of information for policymakers, the media, the health policy community, and the public. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.

About the Associated Press

The Associated Press is an independent global news organization dedicated to factual reporting. Founded in 1846, AP today remains the most trusted source of fast, accurate, unbiased news in all formats and the essential provider of the technology and services vital to the news business. More than half the world’s population sees AP journalism every day. Online: http://www.ap.org

Source: KFF