Campaign Approach to Reaching Rural Audiences

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  • Based on surveys fielded between March and May 2021, the Campaign developed a profile of rural adults to inform its approach to this audience.
    • Rural adults are older and less racially/ethnically diverse than the general population.
    • They are more likely to believe or be unsure about misinformation related to COVID-19 and vaccines compared to those in urban areas, so providing fact-based information about vaccine safety and effectiveness is important.
    • Compared to urban adults, rural adults are less likely to trust public health officials—including HHS and CDC.
    • Rural adults are more likely to be in the Wait and See group than other adults. They are also more likely to be concerned about vaccine side effects and to want to build immunity via exposure compared to other adults.
  • CDC reported in March 2022 that the gap in COVID-19 vaccination coverage between urban and rural areas has more than doubled since April 2021. Vaccine uptake of at least the first dose among rural residents ages 5 and older is 58.5% and in urban counties, it is 74.4%.
    • Also, parents in in rural communities said that their child will "definitely not"get a COVID-19 vaccine about twice as often as those in urban communities. About 76% of rural parents trust their health care providers with information about the COVID-19 vaccine, but nearly 40% of rural parents reported that their child’s doctor did not recommend that vaccine, compared with only 8% of parents in urban communities.

  • In May 2021, the de Beaumont Foundation reported on results from its focus groups research, which focused on why people changed their minds about getting the COVID-19 vaccines. This research confirmed findings from Campaign creative testing focus groups in 2020 that highlighted the importance of acknowledging that it is normal for people to have questions about the vaccines.
  • Encouraging this audience to talk to a doctor or pharmacist to get answers to their questions and pointing out that the majority of doctors are choosing to get vaccinated themselves is an effective appeal for this audience.

Audience Market Research and Testing

A robust and continuous cycle of research drives all Campaign activities, including the approach to reaching rural audiences.

  • Primary research includes focus groups and interviews, creative testing surveys, and a weekly current events survey (a probability-based survey of 1,000 representative U.S. adults ages 18 and older), with findings provided by key demographic groups. Additional research includes audience segmentation and monitoring of news stories, social media, and secondary research. Findings are summarized for use across the Campaign.
  • Additional outcome surveys and analyses, along with social listening, enable performance tracking and real-time impact assessment to inform quick adjustments to messaging in a rapidly changing environment.

Key Messages for Audience

Messaging guidance is based on qualitative and quantitative message testing insights, guidance from CDC, expert recommendations of audience-specific creative agencies, environmental scans, credible external research results, social listening, and iterative testing, among other inputs.

Campaign research has demonstrated that across all audiences, messages that point to the severity of COVID and the benefits of the vaccines are generally most effective. Research has also found that for the Rural audience specifically, the messages below, when used together, are the most effective at driving intention to vaccinate.

  • Everyone in the U.S. ages 5 and older is eligible to get vaccinated. Vaccines are free and available at a location near you. Getting vaccinated has never been easier or more convenient.
    • COVID-19 vaccines are free of charge to all people living in the United States, regardless of health insurance status.
    • About nine out of 10 Americans live within 5 miles of a COVID-19 vaccination site, including doctors’ offices and pharmacies.
    • To find the site closest to you, visit; text your ZIP code to 438829 (GETVAX); or call 1-800-232-0233.
  • When people gather indoors, COVID has more opportunities to spread. You can help stop it by getting vaccinated and wearing a mask in indoor public spaces.
  • Vaccines help prevent severe illness and death from COVID. For the best protection, get your vaccine.
  • The more unvaccinated people there are, the greater the chance COVID-19 has to spread and mutate into more contagious variants that cause severe disease. According to CDC, COVID-19 vaccines are our best defense and are effective against current variants.
  • Children are 4 times more likely to be hospitalized from COVID-19 if they live in a state with low vaccination rates compared to states with high vaccination rates.
  • COVID-19 vaccines provide an opportunity to return to a more normal lifestyle.

Campaign research has also demonstrated that across all audiences, messages which indicate that vaccines and boosters together protect against the worst outcomes of COVID and that boosters extend protection to keep one safe from emerging variants were generally the most effective to drive intent to get a booster shot. For rural audiences, the following messages were shown to be most effective:

  • COVID can cause severe disease, hospitalization, or death. Vaccines and boosters offer you the best protection from the worst outcomes of COVID. (Wave 3 Top Performer for Booster Intention)
  • Just because you had COVID doesn’t mean you can’t get it again. A COVID vaccine and booster are the best way to protect yourself against serious illness, hospitalization, and death.

Partnerships and Outreach

Key Activities and Metrics to Date

  • Communication Toolkit: Created and shared a Rural Community toolkit to provide public education messaging on COVID-19 prevention and to build vaccine confidence.
  • National Partnerships: Working with partners, such as the American Library Association and the National Parent Teacher Association, to reach rural communities through member organizations with in-person events and Campaign messaging materials.
    • Healthy Trucking of America dedicate its booth at the Mid- Atlantic Trucking Show in Louisville, KY, March 24-26 to COVID vaccines, including hosting a Vaccine Pop-Up Event.
  • Regional Partnerships: Partnering (non-paid) with the Appalachian Regional Commission (ARC) to reach their core constituents in Appalachia. The charge of ARC is economic development, and the organization works with small businesses and nonprofits in the Appalachian region. Tactics include:
    • Toolkit: Developed a communications toolkit that focuses on content directed at employers in the Appalachian region. Content includes fact sheets, posters and flyers (for the workplace), social media (to be shared within employer channels), and videos that can be played at the workplace.
    • Testimonials: Developing a testimonial with a business leader on how COVID-19 has presented for the rural communities to share with members of the ARC.

Key Activities

  • Comprehensive paid advertising is directed to rural, non-Hispanic White audiences via national media and in specifically selected local markets around the country. Custom creative for rural audiences is developed for local radio, digital, and social media in regional markets.
    • Digital/Social/Digital Out of Home (OOH): Geotargeting digital and social ads to designated market areas (DMA) and ZIP code level on thousands of sites and platforms, with national placements on sites such as Christian Post, Outdoor America, and NASCAR.
    • Television: Placing ads on networks that over-indexed with Rural audiences, such as The Weather Channel, Fox Sports, Small Town Big Deal.
    • Radio: Geotargeting radio ads to DMA and state level on stations selected by genre/format.


  • Early in the Campaign, Slow the Spread reinforced basic prevention measures, with ads in radio, newspaper, digital, and social media.
  • Building Vaccine Confidence, the Campaign’s advertising push, included TV, radio, newspaper, digital and social media, and digital OOH, initially focusing on seniors as the first eligible population for vaccinations, then targeting health navigators—the health care decision makers in families, young adults, and now parents of children who are eligible for vaccination. Tailored ads to encourage boosters for the vaccinated are also part of the Campaign.

Earned Media

Key Activities and Metrics to Date

  • The Campaign has specifically targeted rural communities through monthly audio news releases with National Association of Farm Broadcasting, resulting thus far in 189 syndicated airings of 13 original releases for a reach of 294,100 impressions.
  • Since May 2021, the Campaign has conducted monthly outreach to four targeted states based on rates of COVID-19 and vaccine hesitancy. In December 2021, we also added states with a large percentage of booster eligible population and states with high numbers of vaccinated parents willing to consider vaccination for their children. Broadcast media tours, proactive pitching, and ready to run articles in this local outreach effort have resulted in more than 5,000 online or syndicated airings of 111 original stories and an estimated reach of 118 million impressions in targeted states with the largest percentage of rural populations.
  • Additionally, interviews appearing online and on national television and iHeart radio programming has garnered 166.5 million impressions in markets where more than 50% of the population is rural.

Trusted Messengers

  • As hunting and fishing are hobbies for many rural adults, the Campaign is collaborating with Outdoor America, a content delivery authority for people who are passionate about outdoor sports and recreation. To date, Outdoor America produced three video vignettes, including one with popular Outdoor America host Mike Auten. The goal of each vignette is to relate to the audience through outdoor content, strengthen confidence in the COVID-19 vaccine, and encourage vaccination.
    • The initial video spots ran both on Outdoor America’s platform and in additional paid digital and social media and delivered more than 13 million total impressions.
    • The Campaign is continuing to work with Outdoor America for additional video content.
  • Additional opportunities to leverage rural trusted messengers are in development with media partners involved in outdoor recreation, sports, and military arenas.

Creative Samples

Contact Us

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