Like many Southern states, Tennessee has a substantial rural population. Of Tennessee's 95 counties, 49 are considered rural by federal census standards. Additionally, nearly 2.9 million Tennesseans reside in rural areas, approximately 46 percent of the state's population. Health reform and the implementation of the Affordable Care Act have been particularly painful to rural populations. Let's review the challenges. First, rural populations face many demographic challenges. Statistically, they have relatively poor health profiles, with high rates of heart disease, diabetes, tobacco use and other chronic health conditions. Additionally, rural areas are home to disproportionate numbers of low-income and aging populations. Unemployment in rural areas usually exceeds state and national norms.