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diego_moita

I see a couple of reasons:

* lower fertility rates

* fewer immigrants

* Covid deaths

* opioids deaths

* increasing productivity in farming with the destruction of small farms and increased economic inequalities

* crumbling infrastructure in rural areas, from closing supermarkets and schools to deficient roads and services

Except for Covid I don't think any of these trends will revert soon. Many of these counties have degraded so much that they might be uncapable of atracting remote workers.

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> * crumbling infrastructure in rural areas, from closing supermarkets and schools to deficient roads and services

I expect many the shine of many of the "pandemic homesteader" stories we've seen will tarnish pretty quickly as a result of this. How much of a discount are you willing to accept on the cost of living at the expense of safe drinking water? Are you old enough to be concerned about reliable emergency services, or access to a hospital? You're not getting a bargain by living in a rural area, you're getting the market price.

Safe drinking water is not really much of an issue in the United States outside of lead pipes in mostly urban areas. If you have a well you know to get it checked every few years. Sometimes it needs to be treated. If you are really concerned you run your drinking water through a water filter. I grew up on a well that was hundreds of years old and only about 15 feet deep. And it is still a good well to this day. Modern wells are hundreds of feet deep and are sealed. They are very safe.

Access to healthcare is an issue depending on the area. There is zero financial incentive for healthcare workers to be in poor rural America. Really, though, it is a poverty issue. Rural areas, particularly those that were built around a specific and now defunct industry, such as coal mining, have a lack of available jobs and they are now unwilling to leave a town that no longer has a purpose to exist.

> There is zero financial incentive for healthcare workers to be in poor rural America.

I've heard the opposite but it was all anecdotal. I heard surgeons and other doctors actually get paid a lot more to live in more rural areas because doctors generally don't want to live there so they have to do something to attract them.

It depends on the particular area and specialty. Surgeons are paid top dollar everywhere. Physicians aren't generally paid well outside of major hospital systems. And psychologists are still viewed suspiciously in many parts of the country.

As far as location is concerned, plenty of areas that are just 10 miles from a major metropolitan area are considered rural for census purposes. Owning a practice in a bucolic part of southern Connecticut is different from owning one in a Gold Rush ghost town. Population density is a still important, even if it matters less than it would for a major hospital system.

Not to mention there's the dating factor. While this may not be an issue for late-career/semi-retired doctors, the younger or divorced ones will face an ethical and professional dilemma regarding dating patients in a small town on top of the usual stressors in being a doctor.

I’m pretty sure by the time you’re done with your residency and are looking for long term employment - you’re in late 20s and early 30s as a doctor and are likely going to be very close to married or are married. Only issue will be if you’re married to another doctor and can’t find another position in that small town.

There are plenty of doctors that come out broken up, divorced, or single right out of medical school. Even though there's a high intra-occupational marriage rate among healthcare professionals, not everyone is in a position to benefit. If a freshly-minted doctor wants to have a chance at love outside of medical school, he/she would be in a better position in a big city than a small town.

There's an awful lot of ground between "unsafe drinking water" and "megacity".

Take Ault, Colorado, just for instance. Google says the population is 1,947. It declined from 2018 to 2019. (Not sure how Google knows that, when there wasn't a yearly census. Maybe better not to ask - Google's surveillance powers aren't the point here.)

Ault is this little small town. It's on a US highway. It's 17 minutes off of an interstate. It's 27 minutes to Fort Collins, a town of 100,000 people with a state university. It's 1:17 to Denver, a city of 4 million people.

So if you need a hospital, there's one 30 minutes away. If you absolutely need a big city hospital, it's an hour away. That's inconvenient, but you (hopefully) won't need it very often. Need an InstaCare type facility? There's probably one 20 minutes away, and almost certainly one 30 minutes away.

Need an appliance store? It's maybe 25 minutes away. Well, mine is 15 minutes away, and I'm in a big city.

Need a non-remote job? There's a fair amount of tech in Fort Collins. I've had worse commutes. (I didn't like them, but I've had them.)

So I'm not seeing the hard dichotomy between "big city" and "completely out in the sticks". It's a continuum.

In rural areas, safe drinking whatever is often up to you. You’ll have a well, and ideally you’ll get it inspected regularly. You should be able to control this, unless there is something fouling all the water in the immediate area. But many people never inspect their wells, and there are way too many pathogens in their water.

I agree up with well water, a septic field, and no sidewalks. Never doing that again. I want to be apart of human progress and have modern infrastructure. The septic field was probably the worst.

I agree. I didn’t want to go to in depth, but I imagine many people who grew up in the suburbs wouldn’t consider the quality of well water when looking at a rural home. How many would research nearby industry to see what might be polluting the groundwater? The mines and factories don’t put up signs saying “Our coal ash pond is leaking into the water table”. There is a lot of work in the modern world to minimize your exposure to environmental toxins and it’s not something we are taught or told we need to know.

I suppose it is something you just need to know. If you are looking at purchasing a home with a well have it inspected. Depending on where you live this may be a requirement for the sale of any home.

I think the bigger trends you've missed are:

* people can afford fewer children, and many no children at all

* I'm guessing here but possibly people are coupling at a lower rate, and are living single long-term

* more people happy to say that they just plain don't want children, and have other interests instead

> people can afford fewer children, and many no children at all

People are much more able to afford children today than in the past, and some of the most affluent places (e.g. DC) are the most childless.

In the post WWII era, it was common for Americans to raise two or three children on a single blue collar salary. That doesn't seem economically viable in recent decades.

People are having less sex too.

Cost is the biggest one I can think of. If you didn't walk out of the hospital with a 8k bill (on a good delivery) and then have to figure out how to afford $1,500 per month childcare after 12 weeks unpaid leave, people would probably have a lot more kids.

There is a simple way to verify this theory. Just look at the fertility rates in Europe. Spoiler: their TFR is lower than in the US

these are addressed under "Lower fertility rate". You have given some reasons for this declining fertility rate.

People aren’t less fertile (or maybe they are - obesity etc) - the additional factor is that they’re choosing to not exercise their fertility.

Fertility rate is defined as number of children per woman [1]. Wether this is because of human choice or something else is irrelevant.

https://data.oecd.org/pop/fertility-rates.htm#:~:text=Fertil....

> Wether this is because of human choice or something else is irrelevant.

If people can't have children you can't fix that as easily as the factors causing people to not choose to have children.

A change to tax codes can immediately help alleviate the latter, for example.

Sorry, I meant "Wether this is because of human choice or something else is irrelevant to it being named Fertility Rate".

Of course you are right that the underlying reasons are all relevant depending on the question, but they are all covered under the umbrella of "fertility rate".

In conclusion I am (pedantically?) arguing the definition of the term Fertility Rate, not anything else.

the poorest people seem to have the most kids, in every culture.

When you're poor, there is no opportunity cost to have kids (although the economic cost remains).

I think most rural counties would struggle to attract remote workers. People have this dream of rural and small town life, and much it may be based on travel to destination rural and small towns, but most of non-urbanized America has little infrastructure, services, or cultural institutions. Good luck even getting a decent Internet connection.

The small towns that have this stuff also have very high cost of living. Small towns and exurbs on the fringes of metros may pick up people as workers can go into cities when they need to for work or play, but you couldn’t pay me to live in most rural counties in this country.

People not from small towns also underestimate the level of substance abuse that these areas have — either from excessive drinking (and often drinking and driving) and drugs. I’ve had multiple high school classmates from my Ohio town die of opioid overdoses.

Now that remote work has opened up as a possibility (at least for fortunate me), this topic now comes up a lot in our house: I'd like to move out of the Bay Area to a very low cost rural area, where we could get a house with land and live like a king and queen. My spouse looks at these areas and points out that sure, we'd save money, but we'd be king and queen of crap. She can more easily see the downsides of non-urbanized America than I can. I'm a shut-in, so I really don't care that a particular rural area has no night life or museums--hell, I basically didn't leave my computer chair throughout 2020-2021, and it was totally fine. But she has more of a social life, enjoys civilization, appreciates city infrastructure, and every time we drive out to look at one of these rural areas, it's really depressing for her to imagine living in one of these places.

I think -if- small towns even -want- to attract remote workers, they'd need to solve this appearance of not at least being part of civilization. That said, the whole "Californians Please Stay Away" meme is common to a lot of small towns across America, so it's likely these places don't want me moving there anyway.

Why wouldn't it be, simply, "The nation socially isolated in 2020, so less [bow-chicka-bow-bow] happened, so in 2021 there were lower-than-average births"?

(Certainly longer-standing trends will continue as trends, but... the "75%" stat seems like it'd point to covid isolation to me.)

Well, at least one source[1] suggests that sexlessness for men was actually dropping during the pandemic, breaking a quite significant trend. Meanwhile, it was rising for women. Seems there is at least room for skepticism, both towards the lackluster amount of evidence as well as what actually happened.

[1]: https://ifstudies.org/blog/number-4-in-2021-more-faith-less-...

You missed one thing.

*Major ongoing cost of living spike (partially due to inflation) for people that would traditionally have kids.

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