Rural voters are heading toward the 2026 midterm elections with household finances and health care at the top of their agenda, according to a new KFF/Associated Press survey that shows concerns about everyday expenses outranking immigration, abortion, gun policy and the conflict with Iran.
Sixty-nine percent of rural registered voters said it is "extremely important" for candidates to discuss the cost of living, the highest share for any issue tested. Health care costs followed at 56%, while 54% cited fraud in government programs. Immigration was considered extremely important by 45% and the conflict with Iran by 42%.
Agriculture and farm policy, despite the survey's rural focus, ranked below those issues at 35%. Abortion was cited by 28% and gun policy by 26%, underscoring how strongly economic pressure is shaping the priorities of voters outside major metropolitan areas.
The same pattern emerged when respondents were asked about problems closer to home. Fifty-seven percent identified an economic issue as the biggest challenge facing their community, a category that included rising prices, weak job markets, low wages, housing affordability and stagnant local economies.
Household expenses were a recurring source of anxiety. Sixty-seven percent said they were at least somewhat worried about affording gasoline or transportation, while 66% expressed concern about health care costs. Food and groceries worried 60%, utilities 59%, and rent or mortgage payments 46%.
Those concerns are accompanied by worsening views of conditions in rural communities. Three-quarters of rural voters now rate their local cost of living as "only fair" or "poor," a 25-percentage-point deterioration from 2017, according to KFF. The poll also found persistent pessimism about local job opportunities.
Access to health care has also become a more prominent concern. Forty-six percent of rural voters said their communities don't have enough doctors or other health care providers, up from 33% in 2017. Thirty-five percent reported an insufficient number of hospitals, compared with 21% nine years earlier.
Economic dissatisfaction, however, doesn't translate directly into an advantage for Democrats. Asked which party they trusted more to handle the cost of living, 40% chose Republicans, compared with 25% who selected Democrats, while 27% said they trusted neither party.
The partisan makeup of the rural electorate is an important backdrop to those numbers. Fifty-four percent of respondents identified as Republicans or Republican-leaning independents, compared with 32% who identified as Democrats or Democratic-leaning independents.
Priorities also diverged sharply by party. Among Republican rural voters, fraud in government programs ranked first, with 65% saying candidates should treat the issue as extremely important. Cost of living followed at 62% and immigration at 56%. Among Democratic rural voters, 80% put cost of living at the top and 72% cited health care costs.
The poll also suggests economic dissatisfaction with President Donald Trump could affect enthusiasm among a segment of Republican rural voters without substantially changing their partisan preference. Twenty-seven percent of rural Republicans said they disapproved of Trump's handling of the economy, and only 59% of that group said they were "absolutely certain" to vote, compared with 79% among Republicans who approved of his economic performance.
At the same time, 98% of rural Republican voters said they were more likely to support a Republican than a Democratic candidate in the midterms. Overall, 74% of rural Republicans said they were certain to vote, compared with 81% of rural Democrats.
The results illustrate a rural electorate that remains strongly Republican-leaning while expressing substantial frustration over prices and health care. KFF found that 57% of all rural voters disapproved of Trump's handling of the economy, while 48% approved of his overall job performance.
Health care presents a somewhat different partisan picture. Republicans held only a narrow advantage over Democrats on which party rural voters trusted more to handle health care costs, 33% to 28%, while significant shares of independents and non-MAGA Republicans said they trusted neither party.
The KFF/AP Rural Voters Survey was conducted online and by telephone from Aug. 12 through Aug. 24 among 2,241 registered voters living in rural census tracts across the United States. The survey was conducted in English and Spanish and carries a margin of sampling error of plus or minus 3 percentage points for the full sample.
