Making Permanent Supportive Housing Work in Rural America

Understanding the Barriers to and Strategies for Implementing Permanent Supportive Housing in Rural Continuums of Care
Matthew Fowle, Cypress Marrs
​Read the Report here.
Homelessness is increasing across the country, including in America’s small towns and rural communities. Between 2018 and 2024, the rural homeless population increased by more than 25 percent. The largest increases were among people experiencing chronic homelessness without shelter. A more robust response in rural areas is needed to meet the needs of this population. Permanent supportive housing (PSH), an intervention that pairs long-term affordable housing alongside voluntary supportive services, has been demonstrated to be effective in keeping highly vulnerable people stably housed. Beginning in the 2000s, the Department of Housing and Urban Development (HUD) adopted PSH as a key strategy in responding to chronic homelessness across the country. However, this model was developed in urban settings, and little evaluative or practice-oriented research has been conducted to understand the implementation of PSH outside of urban areas.


This report draws on 45 semi-structured interviews with rural stakeholders and new analysis of HUD administrative and American Community Survey data to better understand rural homelessness and the role PSH currently plays in addressing it. To conduct the analysis, we created a spatial join between Census tracts and CoCs that is publicly available through the Housing Initiative at Penn's GitHub repository. The report identifies barriers rural organizations face in implementing PSH and examines strategies to overcome them.
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Key findings include:
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  • On average, rural areas have less robust homelessness response systems and fewer PSH beds compared to urban and suburban areas, alongside lower rates of documented homelessness. Continuums of Care (CoCs) coordinate resources and services to address homelessness. 108 rural CoCs serve about 30% of the population. In January 2024, over 126,000 people in rural CoCs, 16% of all those nationally, were identified as experiencing homelessness.

  •  Rural areas are characterized by low population density and geographically dispersed housing, services, and amenities. The low density and small scale of rural communities alongside the underdeveloped organizational capacity—e.g., limited financial resources, staff time, and expertise—among many rural agencies limit the ability of rural communities to develop and operate PSH. While barriers to establishing and operating emerge in all types of communities, together these factors exacerbate the challenges faced by rural communities.

  • Securing support for PSH often poses a challenge in rural communities. Funding to support PSH is technically complex and can become inaccessible in CoCs operating at small scales and with limited organizational capacity. High capital requirements frequently make single-site PSH projects in rural areas cost-prohibitive. Undercounts of chronic homelessness in rural areas can erode community support for establishing PSH.

  • PSH programs frequently rely on subsidy programs, such as the Housing Choice Voucher program, to make rent affordable for their tenants. Obstacles to utilizing rental assistance can arise in rural rental markets. Shortages of affordable rental housing in rural communities can create delays in placing tenants into PSH, and program restrictions on the use of rental assistance subsidies likewise limits the pool of potential units suitable for PSH.

  • Ensuring PSH clients have access to essential services is time and resource-intensive for rural PSH providers. Underdeveloped and thinly distributed supportive services infrastructure along with few transportation options can limit access to services in rural areas. Insufficient long-term funding for supportive services further compromises the frequency and quality of service delivery, especially case management.

  • PSH as a tool for responding to chronic homelessness in rural communities can be supported in a variety of ways by federal, state, and local governments as well as by research and philanthropic partners. Flexible, long-term funding responsive to the needs of rural communities, alongside streamlining the processes of obtaining and maintaining these funds, is useful for standing up and sustaining PSH programs, particularly those operating at a small scale. Additionally, evidence on rural PSH program models and implementation strategies should be developed, and opportunities for peer learning and support, as well as technical assistance, should be sustained and strengthened.
Whether you're a policymaker, researcher, journalist, student, funder, or just someone who cares about housing - we would love to hear from you. Email us at [email protected].