Gun Violence in Rural America Is the Forgotten Public Health Epidemic

National discourse around violent crime and gun violence perpetuates the misconception that gun violence is only a problem in large American cities, interfering with the actual work of driving down gun violence across the country. In 2025, though most large American cities experienced historic declines in their homicide rates,¹ politicians falsely framed American cities as having a rampant and out-of-control crime problem to justify dangerous and ineffective interventions, such as trying to federalize local police forces or deploy military personnel to carry out local law enforcement. This eroded civil liberties and local control,² all while divesting from the evidence-based and community-backed solutions that helped achieve those declines in the first place.³

As this false narrative continues to shape federal policy, public health experts warn that it only further stigmatizes cities—fueling bad policy approaches and reinforcing racial stereotypes—and detracts resources from addressing the growing public health crisis posed by gun violence in rural America.⁴ Research has shown that firearm mortality rates, which include both homicides and suicides, are higher in rural America than in urban areas.⁵ Furthermore, in September 2025, the Center for American Progress released an analysis of data from the Centers for Disease Control and Prevention (CDC)⁶ showing that not only is the overall firearm mortality rate higher in rural communities but also that some of the highest rates of gun homicides are in rural counties.⁷

Ignorance or misrepresentation of the problem of gun violence in rural America means policymakers have imperfect information on how best to make investments and allocate critical resources to reduce harm and prevent future gun violence. Equipped with data that underscore the prevalence of gun violence in rural America, policymakers must pursue evidence-based solutions, recognizing that gun violence is a uniquely American public health crisis that affects every community, regardless of geography or political affiliation.

CAP analysis of CDC data shows that from 2001 to 2024, rural counties experienced higher overall firearm mortality rates than small and medium-sized metropolitan counties and large metropolitan counties. (see Figure 1)

In 2024, rural counties had an annualized firearm mortality rate 45 percent higher than that of large metro counties. There were 16.6 gun deaths per 100,000 residents in rural counties compared with 11.5 gun deaths per 100,000 residents in large metro counties. In fact, of the 50 U.S. counties with the highest annualized firearm mortality rates from 2021 to 2024, 32 were rural, 10 were small or medium-sized metro counties, and eight were large metro counties.

The gap between the number of deaths in rural counties and the number of deaths in metro counties is growing. A 2023 study found that over the prior two decades, the most rural counties experienced the largest increases in total firearm mortality rate from 2001 to 2010 to 2011 to 2020.⁸ In 2001, the difference in the firearm mortality rate between all large metro counties and all rural counties with available data was 2.3 firearm deaths per 100,000 residents. In 2024, the difference was more than twice as large: Rural counties experienced an estimated 5.1 more firearm deaths per 100,000 residents than large metro counties—the largest single-year difference in firearm mortality rate of any year from 2001 to 2024.

These data make clear that rural American communities are disproportionately affected by guns. Yet reporting the data in terms of total firearm mortality rates obscures the true nature of the problem: Rural America is facing two crises of gun-related deaths, one driven by suicides and the other driven by homicides.

Suicide rates across the United States have been steadily rising since at least 2000, and the majority of all suicide deaths involve a gun.⁹ Across all American communities, suicides make up more than half of all gun deaths in counties of all sizes.¹⁰ However, rural counties experience a significantly higher rate of gun suicide than more populous counties. In 2024, the gun suicide rate in rural counties was 12.5 deaths per 100,000 residents, accounting for more than 75 percent of all gun deaths in rural counties. This compares with a gun suicide rate of 9.9 deaths per 100,000 residents for small and medium-sized metro counties and 6.2 deaths per 100,000 residents for large metro counties. This means the gun suicide rate across rural U.S. counties was more than twice as high as the gun suicide rate in large metro counties. The risk of gun suicide in the most rural American communities is so great that it exceeds the risk of gun homicide in the largest metro counties.¹¹

Experts point out that no single factor is driving this disparity between rural counties and large metro counties.¹² Instead, research has found a combination of risk factors driving this epidemic in rural communities.¹³ Greater access to firearms, less social connectedness, more prevalent alcohol use disorders without intervention, and less access to mental health care are more often issues for those living in rural communities and are also all associated with a greater risk of suicide.¹⁴ Additionally, analysis by The Trace shows that the gun suicide rate among older Americans (ages 70+) has been increasing sharply over the past decade, particularly in rural counties, which tend to have older populations compared with suburban and urban counties.¹⁵

Although it is true that the gun suicide rate in rural counties has largely accounted for the growing gap in total firearm mortality rates between rural and more populous American counties, some rural counties are also disproportionately affected by gun homicides.

Using CDC homicide data, a 2021 analysis found that if counted as a nation, a cluster of 21 mostly rural counties—spanning Arkansas, Mississippi, and Tennessee—would have accounted for the fifth-highest single-year homicide rate in the world from 2020 to 2023.¹⁶ After removing the most urban county from that group—Shelby County, Tennessee, which includes Memphis—this cluster would have risen to third highest on that list.¹⁷ Furthermore, it is important to articulate that this is not just a homicide problem; it is specifically a gun homicide problem. Of all homicides recorded in this cluster in 2021, nearly 93 percent were committed using a gun.¹⁸ For comparison, the estimated national percentage of homicides committed using a gun was 79 percent in 2023.¹⁹

Recent CAP analysis found that rural counties have some of the highest rates of gun homicide, and in 2024, the U.S. county with the highest per-capita firearm homicide rate was rural Holmes County, Mississippi.²⁰ In addition to that report, new CAP analysis finds that from 2021 to 2024, half of U.S. counties with the highest annualized gun homicide rates were rural, while 14 were large metro counties and 11 were small or medium-sized metro counties. (see Table 2)

In 2020 and 2021, murders spiked across America.²¹ During the onset of the COVID-19 pandemic, there was a large rise in homicides in both small and large communities. From 2018 to 2021, the firearm homicide rate increased by 37 percent in rural counties, 45 percent in small and medium-sized metro counties, and 51 percent in large metro counties. However, while large metro and small and medium-sized metro counties experienced larger spikes in their firearm homicide rates from 2018 to 2021, it is rural counties that are having the hardest time recovering, CAP analysis shows.

Comparing 2024 firearm homicide rates to 2018 rates shows that rural counties are still experiencing more elevated rates of gun homicides compared with larger metro counties. In 2024, the firearm homicide rate across all rural counties was still 12.7 percent higher than in 2018, before the pandemic. Meanwhile, the firearm homicide rate for small and medium-sized metro counties in 2024 was 8.2 percent higher than in 2018, and large metro counties had a firearm homicide rate 5.6 percent higher than in 2018. (see Figure 2)

Furthermore, many of the rural counties that CAP’s September 2025 analysis identified as having experienced the highest rates of firearm homicides from 2016 to 2020²² still have some of the highest rates of firearm homicides:

• Eight of the 13 rural counties on the list of the 20 U.S. counties with the highest firearm homicide rates from 2016 to 2020 are still among the top 20 counties in terms of annualized firearm homicide rate from 2021 to 2024.²³
• Six of the 13 rural counties saw their annualized firearm homicide rate increase over the 2021–2024 period compared with the 2016–2020 period.
• Washington County, Mississippi, which had the 10th-highest firearm homicide rate of any U.S. county from 2016 to 2020, has experienced a 124 percent increase in its annualized firearm homicide rate; its rate was second among all U.S. counties from 2021 to 2024.

Research on gun violence in rural communities is sparse relative to the literature on gun violence in urban communities, so the question of why smaller communities are seeing more persistently elevated levels gun violence remains open. Rural American communities are less likely to have comprehensive violence prevention agencies,²⁴ hospital-based violence intervention programs, or trauma centers;²⁵ may have longer drive times to emergency services,²⁶ which can mean life or death in treating a gun injury; and may have less access to investigative technology²⁷ that can help law enforcement solve serious gun crimes. All of these things may be contributing to the lack of public safety gains in more rural communities compared with large metro counties. However, it is also notable that these rural counties are often located in states with wider firearm access and weaker gun laws.²⁸

The U.S. counties with the highest rates of gun homicide tend to be in Southern states and states with weak gun laws:²⁹

• In 2024, all but one county among the 10 U.S. counties with the highest rates of gun homicide were located in states that received an “F” grade for their weak gun laws, according to the Giffords Law Center to Prevent Gun Violence’s 2024 annual state scorecard rankings.
  • Seven of the 10 counties that make up this list come from just one state: Mississippi.
  • Louisiana, Missouri, and Virginia are the only other states represented in the top 10.
• Similarly, across all U.S. counties with available data, the average gun homicide rate in counties located in a state that received an “F” grade in 2024 was higher than the average rate in counties with more comprehensive laws.
  • In 2024, the average gun homicide rate in U.S. counties in an “F” state was 7.29 deaths per 100,000 residents.
  • In U.S. counties located in a state that received an “A” grade in 2024, the average gun homicide rate was just 2.88 deaths per 100,000 residents.

Evidence demonstrates that year after year, the states with the weakest gun laws in the country are more likely to experience higher rates of gun violence.³⁰ Mississippi, for example, has recorded the highest gun death rate by state every year since 2021 and has never ranked higher than 43rd in the country in terms of gun law strength.³¹ Despite strong evidence that gun laws can reduce overall gun deaths,³² Mississippi has gone in the opposite direction. In 2016, Mississippi passed a permitless carry law.³³ Shall-issue and permitless carry laws in other states have been associated with a 13 percent higher violent crime rate 10 years after adoption compared with control states.³⁴ From 2018 to 2024, Mississippi’s gun homicide rate increased by 37 percent.³⁵

Furthermore, CAP’s analysis of county data underscores gun violence as an issue that extends beyond American cities. None of the Mississippi counties that appear in the list of the 10 U.S. counties with the highest rates of gun homicides are large metro counties, and, in fact, six of them are rural. The unscientific and often-repeated narrative around gun violence,³⁶ which relies on fear and myths of urban crime and violence, ignores some of the communities that are experiencing the highest rates of violence.

The crisis of gun violence in rural American communities cannot be ignored any longer. Dishonest attempts to frame the problem of gun homicides as an exclusively urban issue and gun suicides as mostly a rural America public health threat come at the cost of lives. More resources, investment, and solutions are needed wherever gun violence is occurring, in communities both small and large. To end the gun violence epidemic in America, policymakers must be informed about where, how, and why gun violence occurs in order to make smart and evidence-based investments in proven solutions.

The data used for this analysis are from the National Center for Health Statistics’ (NCHS) Mortality Data on the CDC WONDER system.³⁷ Gun homicide and gun suicide data are calculated using the Current Final Multiple Cause of Death Data for 2016 through 2020 and the Provisional Multiple Cause of Death Data for 2021 through 2024. Data were aggregated by “Occurrence County” and urbanization level using the 2013 NCHS Urban-Rural Classification Scheme for Counties, which classifies counties—in order of most to least urban—as “Large Central Metro,” “Large Fringe Metro,” “Medium Metro,” “Small Metro,” “Micropolitan,” and “NonCore.”³⁸ Following the precedent used by the Johns Hopkins Center for Gun Violence Solutions,³⁹ while micropolitan and noncore counties can contain nonrural population centers, for this analysis, counties with this designation are considered “rural.” Counties classified as either “Medium Metro” or “Small Metro” are considered as “small and medium-sized metro.” Counties classified as either “Large Central Metro” or “Large Fringe Metro” are considered “Large Metro.” Notably, due to the sensitive nature of the data, counties with fewer than 10 deaths are suppressed and therefore excluded from this analysis. For this reason, part of the analysis uses data aggregated over a four-year period. Annualized gun homicide rates and annualized gun suicide rates are therefore calculated using these aggregated data.