When it started, the COVID-19 pandemic hit cities the hardest. In April 2020, metros with more than a million people had rate of about eight deaths a week per 100,000 adults, according to an analysis by the U.S. Department of Agriculture.

But the situation flipped as the pandemic progressed. In September, rural areas — those with a population less than 10,000 — started to have higher death rates than urban areas.

In December, small towns had a rate of about 10 deaths a week per 100,000 adults, according to the USDA analysis.

Graphic: USDA

The USDA attributed the increase to three factors: 1) rural America’s aging population; 2) the prevalence of underlying health conditions among rural residents; and 3) the long distances many have to drive to hospitals with intensive care units.

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