The first reported case of COVID-19 in rural America was on February 20, 2020. As of January 20, 2022 there have been more than 9.6 million reported cases of COVID-19 and more than 152,000 associated deaths in communities outside metropolitan areas. Between December 20, 2021 and January 20, 2022 communities outside of metropolitan areas reported more than 1.8 million new cases of COVID-19 – a 223 percent increase over the previous month.