Among public health agencies, expanding remote work opportunities by many state health departments (SHDs) has increased the pool of candidates for state positions, including people working at local health departments (LHDs). SHDs often pay better than LHDs, especially when compared with salaries among rural LHDs. Rural LHDs particularly struggle to recruit public health–trained employees, and the increase in remote work options by SHDs may exacerbate rural LHD recruitment and retention challenges. At the same time, having SHD staff who have lived experience working in rural jurisdictions and who reside in rural communities may also be a benefit and can potentially grow the SHD’s connections and responsiveness to their rural constituents.

This article explores perspectives on remote work among rural LHD leaders and how remote work practices among SHDs may be affecting their efforts.