Why Well-Being Is Falling in Rural America

Growing up in Urbana, Ohio, in the ’70s, Beth Macy didn’t have things handed to her. Back then, her dad, seen as the town drunk, was a source of shame—as was being one of the poorest kids in her class. Despite all this, Macy (a journalist and author of Dopesick, adapted as a Peabody-winning Hulu series) was able to forge a different—and, for her, better—path.

An ambitious student, she earned her college degree with the help of a Pell Grant. At the time, her mother made about $8,000 a year test-driving cars for a Honda subcontractor, yet Macy’s college aid covered her room, board, and books. Today, she notes, a student in similar circumstances would receive only about 30% of that support. After graduation, Macy took her first job in Georgia and eventually settled in Roanoke, Virginia, where she still lives.


In her new memoir, Paper Girl, Macy returns to her hometown to explore how life there has changed, describing Urbana as a “microcosm” of the deepening political divisions across America. The experience, she says, gave her “whiplash.” Her main takeaway? It’s far tougher for poor kids to find opportunity now than it was when she was growing up—and this growing inequality in education is contributing to our polarization. 


I spoke with her about the challenges facing rural education, the role of social media in dividing communities, and how to maintain relationships across political divides. Here’s our conversation, edited for clarity.


Hope Reese: Can you describe Urbana? What’s it like today?

Beth Macy: From the outside, you would think it was the cutest town. It’s fairly thriving-looking, with lots of shops where there used to be empty storefronts. There’s coffee out the yin-yang! But I was hearing terrible stories from people who worked in the schools—about attendance, the level of trauma, the number of kids that have been sexually abused who were in foster care. The fact that the graduation rate had gone down. The fire chief told me about all the emergency calls—how mental health calls for emergencies had multiplied by nine since 40 years ago. Childhood poverty has increased by three times since I left. Foster care placements tripled since 2015.

HR: When did you realize that you could look at your own hometown as a lens to explore the divide across the country?

BM: I wrote a piece for the New York Times right after my mom died [about our political differences], which was published in December 2020. Right away, there were hundreds of comments—and it made me feel not so alone. They were about other families, people who could barely speak to their siblings. To hear all the pain people were experiencing, I thought, “Wow, I really hit a nerve.” I had always wanted to write a memoir as a way to point out how critical higher education was to me. I felt that the removal of the ability of poor kids to go to college was a really important and untapped storyline.


The more I started to parse it, it seemed like the college gap was a big creator of the partisan divide.

HR: So what’s going on, exactly? And is that reflective of what’s going on in other small towns across America?

BM: Rural places have been disproportionately impacted by the China shock, and the loss of jobs to offshoring. And many rural places were disproportionately impacted by rapacious pharmaceutical company practices. In fact, if you overlaid maps of job losses and overdose deaths, you would see that the places where the job losses hit hardest were places that the pharma companies targeted the most. They knew there would be more people with workplace injuries, people with Medicaid, and they could sell more pills.

They don’t have much in the way of harm-reduction services. They have a new [federally qualified health center], and they’re doing really great stuff. But almost as soon as they opened, they had a huge waiting list for substance use disorder treatment and mental health emergencies. In fact, they keep two slots open every week for suicidal calls. And seeing a counselor is like a six-month waiting list. There’s just a huge need for mental health services.

HR: What surprised you when you looked more closely at what’s happening in Urbana?

BM: Attendance. Just general attendance—not just in schools, but in the workplace. And when I talked to someone in the school system, who helps students figure out if they’ll go to college, military, or into the workplace, she said “how to human.” I asked, “What do you mean?” She said that they’re lacking basic skills—like they don’t know how to ask for a pencil.

And then there’s the time I’m with the truancy officer and all of a sudden we’re outside of this gorgeous farmhouse. Postcard-perfect, and they have a sign saying they might shoot us. She needed to leave a note that they hadn’t filled out their permission-to-homeschool slip.

Now, more and more states are enacting laws, giving parents more “rights,” pushed by a lot of Christian education lobbies. It’s really harming kids whose parents are using (and I quote) “homeschooling” as a way to get out of getting up in the morning and getting their kids off to school. That’s what I saw the truancy officer dealing with over and over again.


HR: You called the book Paper Girl, which ties right back to your early connection with journalism. Was that world—and its decline—something you planned to center in the book from the start?

BM: When I first started working on the book, I thought that would be a bigger piece of the book. You know, we call it Paper Girl because I delivered the paper and wrote for papers. The decline of legacy media is part of what was causing this [political] divide. But if I look back on it, it’s this lack of knowledge base overall that includes both the demise of fact-based media and the fact that almost half of our country doesn’t believe fact-checked articles for publications that you and I both write for.

HR: You don’t agree with everyone in your family, politically. How do you maintain these difficult relationships?

BM: I think you have to get back to who you are as people, and siblings. My brother said he wanted to come and see our new cabin out in the country—he’s a country person, and it’s on a creek, and he’s a fisherman—and then he actually came, after he hadn’t really visited me in five or six years because of all the “liberal shit” I used to post.

We had both gotten away from Urbana, but we would see each other. He’s a very tender person. When he visited the cabin, he taught me how to fish again and fix some things because he’s a great fixer of things. It actually fixed our relationship in some ways. He had done bridge work, extending grace.

It really does come down to the people in your life, meeting people where they are and trying not to snap to judgment so quickly. We all have our various signs and flags on our houses. We’re all in bubbles, right? But we should at least be doing the work to figure out why so many people hate each other in this environment. People have a right to be mad. The Right, I think, has used that as a political weapon.

HR: Can you talk about witnessing how relationships and friendships break up over social media posts?

BM: When Trump was running the first time, the deacon at [my ex-boyfriend Bill’s] church, where he had been very active, takes him out for a beer—but really is quite upset with him because he said he’s going to vote for Jill Stein. (He hated Hillary with a passion.) The deacon and Bill had been best friends and even roommates, and they broke up over the first time Trump was elected.

So he’s losing his faith leader and his best friend. His kids don’t agree with him. But who agrees with him? These people on the internet. And it becomes his whole world. If the internet wasn’t around, he wouldn’t have run into these people that had these extreme beliefs. It gave him this community that I think he was lacking in real life.

HR: Religion is an integral part of the fabric of our country, but it’s played a more prominent role recently, blurring the line between church and state. How did you observe this in Urbana?

BM: That was shocking to me. Homeschooling is the fastest-growing education movement in the country. It falls under the rubric of “parents’ rights.” That money doesn’t go to that school district—and it dilutes the quality of the education for the kids left behind. So Urbana becomes even more of a disproportionately at-risk school population.

For the kids who are going, you have things like this program called Lifewise, which pulls kids out of school during non-core classes and literally takes them to a church on a school bus. The kids go back and they become recruiters for other kids to go because they get fed candy and pizza and they play fun games. But what are they missing at school?

They’re missing their specials, which were like times where they could go to counseling for the issues they were having at home. And I was like, “That’s kind of a big deal to miss.”

It’s due to the growing power of the religious Right. They’re advertising “vote no on issue one,” which was the abortion amendment, on church signs. They’re not supposed to do that. They’re not supposed to be both tax-exempt and say things like that on their signs.

HR: If you grew up in the same circumstances today, you may not have gotten to where you are now, right?

BM: Right. The middle class is basically hollowed out. Those who could leave, left. There’s a widening group of folks that have mental health and addiction problems and physical health problems and aren’t able to show up to work every day or send their kids to school every day. When I was growing up, not going to school was just unthinkable.

I thrived at school and had these really loving teachers, and I met these folks who were middle-class whose parents looked out for me. One mom made me lunch every single day in high school. Egg salad, tuna salad, chicken salad—and then we’d go back to egg.

Her dad had been an alcoholic, too. And when I was upset, I could talk to her. I had great friends that not only helped me with things like rides home from band practice or softball practice, but also showed me a path forward.

HR: You are a prize-winning author, a college graduate. Yet you write about telling a friend you still have the feeling that you are on the “precipice of disaster.” What does that feel like, and what does it mean for those who haven’t come as far along?


BM: We were talking about something I might be doing in the future. And I was nervous about it. He said, “Uh, why are you nervous? You’re such a success.”

I said, “I don’t know, there’s just something in my core. It’s part of my fuel. It’s this chip on my shoulder. It’s part of why I hustle. I’m almost always the hardest-working person in any group I’m around. It’s my Achilles and my best quality.”

I had this really feisty mom who always taught me not to take any shit from anyone. She has been my touchstone my whole life. I have this just bottom-line grit that I wouldn’t have had, had I grown up with a trust fund or had everything handed to me. So I’m very grateful. The world had to meet me where I was, right?

I would still be in Urbana. I might have a substance use problem. I don’t think I would be happy or productive had I not gone to college. It introduced me to a world where life was richer, easier, and much more interesting than the world I had known as I had known it.