In rural areas, residents can be miles away from essentials like doctors and grocery stores instead of minutes. Without transportation, people who don’t have a car or can’t drive often have to move closer to services.

More than a third of state rural health offices reported lack of transit was the biggest barrier to elderly people staying in their homes, according to research from Carrie Henning-Smith, who studies rural health at the University of Minnesota.

Rural America tends to be sicker, poorer and older than its urban counterparts. Henning-Smith said the negative-but-true statistics make it even more important for rural residents to be able to access transit.

“There’s greater need for transportation among older adults in rural communities, but more transportation challenges in getting people where they need to go,” she said. “And that will only increase as the years go on, and the population continues to age in rural places.”