Advancing Rural Opioid Use Disorder Care: Workforce Strategies Under the Rural Health Transformation Program

Despite federal investment in rural health transformation, many communities still face a critical shortage of clinicians, peer specialists, and community health workers equipped to address opioid use disorder (OUD). Recruitment alone isn’t enough — rural systems must also focus on retention, training, and workplace support to build sustainable, stigma-free substance use treatment environments.

CMS’s Rural Health Transformation Program (RHTP) offers an historic opportunity to reenvision the behavioral health workforce. When used strategically, RHTP funding can expand entry pathways to person-centered substance use treatment and create supportive conditions that keep experienced staff in the field.

The Workforce Challenge: Beyond Numbers

Rural health systems often operate with inadequate staffing, limited specialty care, and high burnout. Studies confirm that workforce shortages remain one of the most persistent barriers to OUD treatment in rural areas — particularly due to the scarcity of qualified addiction medicine specialists and psychiatrists.

Systematic reviews identify additional rural-specific barriers such as long travel distances, broadband limitations, and a lack of behavioral health integration in primary care. The HRSA National Advisory Committee on Rural Health and Human Services similarly notes that rural counties face compounding challenges — including stigma, limited prescribers of medications for opioid use disorder (MOUD), and constrained telehealth infrastructure — that undermine workforce recruitment and retention.

Not only do these realities contribute to workforce shortages but also to rapid staff turnover, disrupting continuity of care and eroding patient trust in rural OUD treatment systems.

Leveraging the RHTP for Workforce Innovation

The RHTP framework allows states to braid funding across infrastructure, access, workforce, and technology initiatives — offering flexibility to target the opioid workforce crisis directly. RHTP funds can be used to:

• Support education and training pathway: Scholarships, stipends, and supervised placements for students entering addiction medicine, behavioral health, or peer recovery roles.

• Expand rural residency and fellowship programs: Incentivize training in MOUD, person-centered and culturally responsive care.

• Fund loan repayment and incentive programs: Reward providers who commit to multi-year rural service.

• Create hybrid telehealth models: Enable virtual supervision and mentoring to reduce professional isolation.

• Invest in peer and community roles: Train local residents as recovery coaches, community health workers, and substance use navigators to extend the care workforce beyond licensed clinicians.

These recommendations echo calls from national experts to invest in workforce pathways and integrate training, telehealth, and peer services into the OUD continuum of care. Together, they align with RHTP’s vision of a multi-sector, sustainable approach to rural transformation.

Building a Culture that Retains Person-Centered Care as Workforce Strategy

Recruitment incentives can bring people in — but culture keeps them there. Person-centered principles like respect, collaboration, and meeting people where they are can also serve as organizational values that sustain the workforce.

Emerging evidence shows that organizational culture — including supervision quality, inclusion of staff with lived-experience, and a strong peer workforce — directly influences retention and job satisfaction among substance-use peer supports.

Integrating person-centered values into workplace structures can:

• Reduce burnout by replacing moral judgment with curiosity and compassion.

• Strengthen interdisciplinary collaboration and shared purpose.

• Empower peer and lived-experience staff through fair pay and leadership opportunities.

• Reframe rural OUD care as relationship-based, not compliance-based work.

Programs that embed reflective supervision, peer mentorship, and trauma-informed organizational practices see markedly higher retention rates.

Looking Ahead: Turning Workforce Vision into Action

At Aurrera Health, we help states and counties turn health care policy ideas into reality. The success of rural opioid response depends not only on new programs or technology—but on people. Building and sustaining a skilled, compassionate workforce is at the heart of rural health transformation.

Through our work with state agencies, county leaders, and community-based organizations, Aurrera Health helps clients design and implement strategies that invest in people as the foundation of lasting change. We support:

• Flexible training pathways that braid Rural Health Transformation, State Opioid Response, and opioid settlement funds to grow the behavioral health and peer workforce.

• Workplace cultures rooted in patient-centered care, where supervision, team structures, and policies are designed to support retention, collaboration, and wellbeing.

• Integration of lived experience by formalizing peer recovery roles and elevating community leadership within rural systems of care.

By viewing workforce development as both a public health and community development strategy, Aurrera Health helps clients to move beyond temporary fixes— building sustainable, people-centered systems that expand access to OUD treatment and recovery support across rural communities. If you’d like to learn more, please reach out to Kelly Murphy.

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Author

Kate Roberts [Deputy Director]