The Pleasant View housing development is seen off of Newry Lane in Duncansville. Mirror photo by Patrick Waksmunski

While Pennsylvania is best known for its marquee metropolises of Philadelphia and Pittsburgh, its beating heart is, arguably, found within the farms, forests and rolling mountains that thousands of rural communities and their residents call home.

But this reality is in jeopardy, according to the state Rural Population Revitalization Commission, which held a panel discussion in Altoona late last month.

Established by Act 21 of 2024, the commission connects local stakeholders and state legislators to create “reviews and recommendations aimed at attracting and retaining residents in rural Pennsylvania while addressing challenges facing rural communities due to population shifts and changing demographics,” per its website.

According to the Center for Rural Pennsylvania, 48 of the commonwealth’s 67 counties are considered rural, which represent more than 25% of its total population.

A similar proportion of students attend public schools in rural areas in Pennsylvania, although almost half of the 500 school districts they attend are considered rural.

The population of these areas has experienced slow and steady decline with few exceptions.

Blair County lost nearly 500 people from 2020 to 2025, Bedford County lost 486 in that time frame while Cambria County shrank by nearly 1,800 people, according to data from the Center for Rural Pennsylvania/Penn State Harrisburg.

These three counties are projected to lose an average of 7.97% of their 2020 population by 2050, according to the same data.

That would constitute a loss of millions of dollars in local tax revenue, hundreds of empty seats in public schools and an incalculable erosion of these communities.

Economic growth

Municipal governments, public schools and small businesses are sustained by revenue generated by their local tax base, which is a crucial source of revenue.

According to ABCD Corp. President/CEO Stephen McKnight, overall population decline is not in and of itself a good indicator for economic growth or stagnation.

It is one factor to consider among many.

Many population centers in rural areas historically grew around a freestanding economic engine like a large coal mine or paper mill, which drew residents from across the region in search of new opportunities.

“In communities like Blair County with a heavy industrial history, high points in population numbers were often driven by a single industry, such as here with the railroad,” McKnight said. “As industries changed or died, people moved on for the next opportunity and numbers decreased.”

Diversifying the industrial base increases the resiliency of the local economy, and in turn its population.

The health care, manufacturing and retail sectors have become leading employers in Blair County since the decline of the railroad industry in the late 1960s and early 1970s.

While Blair County has shrunk in population, its gross domestic product has risen steadily, McKnight said.

“Businesses are doing more with less. We may never see high population numbers like we did during the railroad times. Rather, we are more likely in the process of establishing a new, modern top line number,” he said.

According to McKnight, making Blair County more attractive to prospective and current residents is the No.1 goal for his organization.

That includes modernizing the region’s housing stock, building outdoor recreational assets and “telling our story to a global audience.”

‘Optimistic’ about Cambria County

Cambria Regional Chamber of Commerce President/CEO Amy Bradley is “optimistic” about her county’s future in light of population decline, especially after some encouraging feedback from the community.

In 2021, the chamber ran a pilot program offering $2,500 relocation stipends to entice people to move to the area.

According to Bradley, the program received 48 applicants for 10 stipend awards, far exceeding the chamber’s expectations.

That number is especially surprising, Bradley said, because $2,500 is barely enough to cover the cost of a professional moving service.

The program received applicants from all over the country, including from California, Colorado and Maryland.

Bradley attributes this interest to several key factors that reflect the value of the county as a whole.

The temperate climate of central Pennsylvania is a big reason for relocation, Bradley said.

One of her neighbors moved to Cambria County from Texas, she said, and remarked at how they weren’t able to comfortably go outside for several months of the year at their previous residence due to the scorching temperatures during the summer.

In central Pennsylvania, residents are able to experience all four seasons without extreme outliers, Bradley said.

The low cost of living compared to major East Coast cities is another big draw for the region, Bradley said.

Many people who move to Cambria County find that they can afford a beautiful home and nice lifestyle after struggling to get by in their previous urban locale, she said.

In addition to the low cost of living, Cambria County has abundant opportunities for outdoor recreation and arts events, Bradley said, which are other attractive aspects for prospective residents.

“It’s something to talk about and market to stem population loss, and I’m optimistic we can do it,” Bradley said.

Centre County has a niche

With Penn State University and a number of sizable health care facilities, Centre County occupies a distinct niche in rural Pennsylvania, as it’s one of the few counties projected to increase in population over the next 25 years, according to Todd Dolbin, vice president of economic development for the Chamber of Business and Industry of Centre County.

The CBICC made population change a central focus in its 2024 Centre County Economic Development Plan.

According to data included within this plan, Centre County is projected to grow by nearly 20,000 people in 2050, after a brief decline expected toward the end of the 2020s.

As the largest public university in the commonwealth, Penn State’s flagship University Park campus is the center of gravity for the economy in its surrounding area.

According to the Happy Valley Adventure Bureau, the university generates an estimated $1 billion in annual economic activity.

That makes Centre County a net importer of jobs, Dolbin said, with 46% of its workforce commuting from surrounding counties.

As an importer of jobs, Centre County has a high rate of international migration comparable to its rate of annual domestic immigration, according to the comprehensive plan. In other words, for every State College resident who moves out, a similar number of people are moving into the area.

Because of this unusual trend, there is an incredible need for more rental housing units to support this growth, Dolbin said.

Bedford County has ‘robust job market’

In recent years, Bedford County’s population has been more stable than its comparable neighbors due to its diverse manufacturing sector, according to Bedford County Development Association President/CEO Bette Slayton.

The number of different manufacturing businesses in the area allowed the economy in Bedford County to weather the pandemic better than its sister counties, she said.

“Having a robust job market helped retain people,” Slayton said.

According to Slayton, quality of life improvements are key to recruiting and retaining workers and businesses.

For both of these groups, feeling valued and supported is critical.

“Companies like to know that they have a partner within the community and they like to feel appreciated,” Slayton said. “I think they get that more in a rural area, so we’re available to take their calls on a broad range of issues on things right here.”

Unlike densely populated urban areas, rural living often gives residents a more direct connection with their communities.

Being able to chat with local officials at municipal meetings and school superintendents at school board sessions is a level of unfettered access that is rare outside of rural areas.

That level of face-to-face interaction fosters close connections between the different stakeholders in a community, Slayton said.

Business, government and local citizens all working in close coordination toward a common goal is one of BCDA’s long-term hopes.

“I’m very bullish on Bedford County’s future,” Slayton said. “We have a community that works together on meeting the challenges in front of us. We have a diverse and growing economic base, in terms of manufacturing, distribution, agriculture, hospitality … the service sector and even insurance.”

Health and wellness

In rural counties, the local hospital or health clinic often serves as an anchor for the community, offering both jobs and essential services for residents.

But without qualified staff to run the facility, these providers may scale back their services or close down entirely.

“Workforce has been the top issue in health care for the past 30 years, and it still is,” Pennsylvania Office of Rural Health Director Lisa Davis said.

Finding and retaining staff is already a challenge in urban areas and is increasingly difficult in the country.

“Rural health care is so important because, to have a robust health care delivery system, you need a robust community,” Davis said.

That codependence can create a negative feedback loop, as declining populations in rural towns can leave local health clinics understaffed, forcing them to offer less services and subsequently lowering the appeal of a town to prospective residents.

Without a nearby health care center, patients in rural areas may have to travel hundreds of miles away to access essential services or specialists.

Geographic proximity to a health care facility can mean life and death in some cases, Davis said.

Medical emergencies such as heart attacks must be treated promptly to prevent lasting damage and/or death.

With strokes, a single hour delay in treatment time can be the difference between recovery and lifelong cognitive impairment, so having a health center nearby is critical.

That phenomenon is readily apparent in maternity care, Davis said, as being able to reach a hospital in 30-45 minutes from the onset of labor can increase the likelihood of positive outcomes for both mother and child.

UPMC Altoona downgraded their trauma center from a Level II to a Level III designation in September 2024, meaning that patients requiring intensive services must travel to either Conemaugh Memorial Medical Center in Johnstown or Penn Highlands DuBois, which are Level I and Level II centers, respectively.

Pennsylvania is ranked sixth in the nation in percentage of seniors within the total population, according to the Office of Rural Health,

These residents may have limited mobility and experience using a computer, which compounds the underlying difficulties in accessing health care services while living in a rural area.

More than 25% of Pennsylvania’s rural population live in federally designated Health Professional Shortage Areas compared to 1.7% of their urban counterparts, according to the Office of Rural Health.

Without easy access to a primary care physician, rural residents have increasingly relied on telehealth services, especially during the pandemic, Davis said.

Telehealth doesn’t replace the value of an in-person appointment with a doctor, she said, but it can help rural citizens build a relationship with a primary care physician, even without a physical health clinic.

“It’s amazing what can be done with telehealth, it’s really remarkable,” Davis said.

Local government

Officials from rural municipalities — which constitute 64% of the state’s total — are on the frontlines of the struggle against population decline.

Duncansville Borough Manager Rodney Estep said there are three main ways to attract residents — provide jobs, expand access to health care and provide abundant options for recreation.

Promoting and investing in recreational assets, like the 9/11 National Memorial Trail that runs along Third Avenue in the borough, is one way to make rural communities more appealing for residents, Estep said.

According to Mayor Eric Fritz, the population of Duncansville has remained fairly consistent through his six-year tenure, but he is still aware of the issue.

“The fewer people there are, the smaller the tax base, and that’s roads, police, firefighters, parks,” Fritz said, noting that providing less of these services and amenities discourages immigration to the area.

Another concern is retaining current residents, Fritz said, as he has seen many young people leave Blair County in search of better job opportunities elsewhere.

Providing high-paying jobs and entertainment options is one way to stem this flow, he said.

Small towns like Duncansville are “nest egg communities,” Fritz said, that, if young people choose to stay and put down roots with their families, they will see a return on their investment as the community grows and improves over time.

State Sen. Judy Ward, R-Blair, served as a panelist for the RPRC meeting that took place in February, speaking alongside representatives from the state Department of Community and Economic Development, County Commissioners Association of Pennsylvania and the Pennsylvania State Association of Boroughs, among others.

“Altoona and Hollidaysburg are sort of the hub here, but the rest of the county is extremely rural,” Ward said, “we love our rural life, but it does present some challenges.”

According to Ward, rural municipalities often struggle with grant writing and applications, which is an area the RPRC works to support.

“As a representative of five rural counties, I am grateful for the work the Rural Population Revitalization Commission has done so far in highlighting the importance of helping rural Pennsylvania succeed,” Ward said in a statement.