Gaps in artificial intelligence research for rural health in the United States: a scoping review

Artificial intelligence (AI) has impacted healthcare at urban and academic medical centers in the US. There are concerns, however, that the promise of AI may not be realized in rural communities. This scoping review aims to determine the extent of AI research in the rural US.

We conducted a scoping review following the PRISMA guidelines. We included peer-reviewed, original research studies indexed in PubMed, Embase, and WebOfScience after January 1, 2010 and through April 29, 2025. Studies were required to discuss the development, implementation, or evaluation of AI tools in rural US healthcare, including frameworks that help facilitate AI development (eg, data warehouses).

Our search strategy found 26 studies meeting inclusion criteria after full text screening with 14 papers discussing predictive AI models and 12 papers discussing data or research infrastructure. AI models most often targeted resource allocation and distribution. Few studies explored model deployment and impact. Half noted the lack of data and analytic resources as a limitation. None of the studies discussed examples of generative AI being trained, evaluated, or deployed in a rural setting.

Practical limitations may be influencing and limiting the types of AI models evaluated in the rural US. Validation of tools in the rural US was underwhelming.

With few studies moving beyond AI model design and development stages, there are clear gaps in our understanding of how to reliably validate, deploy, and sustain AI models in rural settings to advance health in all communities.