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Rural Poverty

Rural Poverty, Illegality, and Healthcare Access in Immigrant Farmworker Families Hazel Velasco Palacios*, Hazel Velasco Palacios,

Healthcare access among immigrant farmworker families is often analyzed through individual eligibility or legal status, obscuring how illegality and rural poverty intersect to shape care across households and generations. This article examines how legal precarity, low wage agricultural labor, and rural institutional scarcity structure healthcare pathways among immigrant farmworker families. Drawing on interviews with undocumented households, mixed status families, and permanent residents in Pennsylvania’s dairy and mushroom industries, the study analyzes how families navigate illness, caregiving, and access to care over time. Findings show that healthcare is rarely accessed through stable institutional channels. Instead, families assemble care through employers, nonprofit intermediaries, schools, churches, and transnational networks. Legal precarity operates not as a single barrier, but as a structuring condition that shapes who can pause work, who absorbs caregiving labor, and how illness is managed across the life course. These dynamics reproduce rural poverty that is not only economic, but institutional and intergenerational, as families expend social ties, bodily health, and transnational resources to compensate for absent or inaccessible care. By foregrounding family level survival strategies, the article shows how healthcare access becomes an intergenerational mechanism through which rural poverty is reproduced. Parents delay or forgo care to preserve income and employer goodwill, while children absorb caregiving labor, emotional strain, and long-term health consequences. The findings demonstrate that expanding formal eligibility or emergency coverage alone is insufficient in rural immigrant regions. Effective interventions must address transportation, language access including Indigenous languages, flexible scheduling, and the role of trusted intermediaries rather than assuming clinics function as neutral entry points. Addressing healthcare inequities in rural immigrant regions therefore requires policies that recognize family systems rather than individual eligibility alone.