Hamilton, Mont.

Lindsey Flather is exactly the type of student that colleges and employers in rural states know they must do a better job of reaching.

A working mother in her thirties, Flather decided to pursue a new career in health care after moving to the Bitterroot Valley in 2018. It was, she thought, one of the only financially sustainable paths that interested her in this growing pocket of western Montana. And she is urgently needed. In Montana, 52 of 56 counties — including Ravalli County — are considered medically underserved, and nearly half of the state’s nurses say they plan on retiring or leaving the profession in the next five years.

But the obstacles to retraining adults in rural areas like this are many. Almost every day last semester, for example, Flather had to commute two hours round trip to Missoula College, just to take an hour-long chemistry class that wasn’t offered at its local satellite, Bitterroot College. 

She was only able to make it work because her mother-in-law could watch her toddler during the day. But that’s not the case for many mid-career adults who are quickly becoming the main target for states trying to retrain their workforces. Many of Flather’s peers struggle to keep up, like the mother of five whose husband works construction and often can’t find childcare.

“There are a lot of ambitious students out here,” Flather says, but distance makes it difficult to make it all the way through to a new career. “Once we have the pre-reqs done here, we’re either stuck taking a job without much of an opportunity to advance, or we have to commute, which takes time and money.”

At the same time, employers are desperate to get more people through these workforce pipelines. They, too, are challenged by geography, says Rebecca Conroy, the chief transformational officer at Bitterroot Health, a regional hospital in western Montana. 

Since the pandemic, Conroy says, her essential workers have been priced out of their own community, displaced by in-migrating teleworkers as housing prices spiked during the real estate runup. For the first time in her three-decade career, the problem isn’t finding enough doctors to hire. 

Conroy suddenly has plenty of highly skilled providers wanting to move to the area, recently made famous by the series “Yellowstone,” which is filmed partly in Ravalli County. Now they can’t attract enough medical assistants to support them.

But even after Bitterroot Health raised their pay to $20 an hour, many medical assistants can’t afford to live there. The median rent in Hamilton, the valley’s biggest town, is now $2,087, up 30% over the previous year. The lack of affordable housing makes it almost impossible to recruit out-of-towners, and the in-town workforce is drying up. The talent pipeline is thin, Conroy says. And the pressure is only growing.  


Bitterroot Health in Hamilton is experiencing such a large shortage that it is considering educating would-be medical assistants on site, particularly as local higher education institutions haven’t been able to meet their workforce needs. Photo: Nick Fouriezos

Across America, rural workforces have been stretched beyond recognition in the wake of the pandemic. The sudden move toward telework has shifted housing and labor markets, creating a crisis of affordability for long-time residents plus a growing demand for hands-on labor in health care, construction and other fields. Amid rapid change, colleges are struggling to adapt fast enough to meet their communities’ needs. 

Take the path to becoming a medical assistant. With an aging population — nearly a third of Montanans will be over 60 by 2030 — comes a huge demand for health services. But Bitterroot Health is struggling to fill about 20 open medical assistant jobs. With so many positions empty, Conroy says, rural patients are experiencing longer waits for care, assuming care is available at all.

Employers like Conroy are the canaries in the coal mine of a growing talent shortage across the country. So smoothing the route to jobs like medical assisting has become a key focus of Montana’s government and educational infrastructure. The state’s colleges recently partnered with the national nonprofit Education Design Lab to interview Conroy and local business leaders statewide about how they might create new educational opportunities, like a set of micro-credentials to allow people to build key skills in shorter courses over time. That, they hope, will better prepare students, while making learning more accessible and getting them into the workforce faster.

A key part of the Design Lab’s work is identifying what skills employers need most. The conversations helped Conroy articulate her changing needs. She began talking less and less about the skills she had originally outlined in the job description, like medical expertise and pharmaceutical knowledge. 

Instead, she spoke about staff members having to calm angry patients frustrated by their care or having to wait weeks to see overbooked providers. Some days, Conroy said, medical assistants spend more than half their shift taking phone calls from suicidal patients, trying to talk them down from the brink and get them the help they need. 

De-escalation, Conroy realized, is the No. 1 job requirement these days. And she needs colleges to start teaching that.

“It’s becoming a skill set that all of our staff need,” Conroy said. “People are simply not their best selves since COVID.” 


Education Design Lab policy expert Minzi Thomas (center) leads a listening session to get feedback from Missoula College students about what obstacles they face in pursuing higher education, and how the state could better support them. Photo: Nick Fouriezos

Rooting out, and then meeting, specific and surprising education needs like those are exactly what Montana and other states hope more flexible, skills-based education systems can achieve. 

Minzi Thomas, a policy expert with the Education Design Lab, suggested that the lab could add de-escalation and suicide prevention programming into curricula the lab and Montana colleges are collaboratively developing. Flather says such training would definitely benefit students like her. She took a four-week fast-track course at Bitterroot College last year that allowed her to start working as a certified nursing assistant at Bitterroot Health. 

“I had not received much training in school or at work on how to handle those situations: how to act, what not to say or ask about,” Flather says. “It’s unfortunate that we’ve gotten to the point where we need it, but it would be great to have more education on that.” 

In addition to talking with employers, the state is asking students for feedback about what they need and what gets in their way. 

At a recent discussion at Missoula College, one student said she was struggling to juggle three jobs while studying communications so she can help run her grandmother’s swing-set business. Another said pre-college placement tests are a daunting requirement. “Finding a good-paying job that respects a student’s schedule is challenging,” another added.

When Flather was asked how employers could help, she thought about how much her life has shifted since she graduated from the University of Colorado in 2009, just two years after the iPhone came out. 

In an accelerating world, employers had to know that change might be the only thing that students like her could plan on. “Providing more resources and ongoing training is super huge, especially the way technology in any career is advancing, constantly,” she said.


The challenges that both rural students and employers face are familiar to Sarah Swanson, Montana’s labor commissioner. The former owner of a John Deere dealership in northeastern Montana, she remembers struggling to find highly skilled workers because there wasn’t a single state college or university in her 14-county region.

About 66,000 working-age Montanans in 2023 worked only part-time or not at all because they can’t access childcare, which often means they can’t travel to take classes, either. “That’s why expanding access to place-based education is so important,” Swanson says.

While rural areas have long faced workforce challenges, the problems have been exacerbated by the rapid pace of change. Nearly three of four jobs that don’t require a four-year degree are under-supplied by Montana education institutions, according to a workforce report published by Swanson’s department in 2022. 

Too often, information is outdated by the time colleges create new curricula and implement it, Swanson says. That’s driving Montana and other states to work with the Education Design Lab, to create flexible, skills-based education opportunities that can more quickly adapt to workforce needs. 

The Education Design Lab and higher education officials from across Montana recently met at Missoula College to create micro-credential pathways that could help the state better address its workforce shortage in key industries. Photo: Nick Fouriezos

After interviewing business leaders and students, the Design Lab puts together course modules made up of skill-based “badges” that can be mixed and matched to quickly create new types of curriculum. That malleable, feedback-driven process is meant to benefit employers because students get tailored training for specific careers. Students, in turn, can be more confident that their education will immediately lead to a paying job or contribute toward a degree down the line.

Students can see online what jobs they can get with different credentials and how additional education (such as another certificate or a degree) could increase their pay. The state also tells them which employers have verified a credential, signaling that graduates of the program would automatically qualify for their jobs upon graduation.

Having specific information about where an education can lead will give people more incentive to pursue training, despite barriers, Flather says. “It’s huge to have something very clearly organized and laid out, because a lot of the pay isn’t transparent or easy to find.” 


Still, all those changes might not come fast enough for employers like Conroy, who needs to fill jobs now and be able to trust that her hires can handle the work.

Montana already offers a non-credit, four-month training program for medical assistants, but it’s not enough, she says: “It’s a really abbreviated program. They have really saved our bacon with that program, but man, there has been some collateral damage. These folks are coming in greener than green.” 

To fill the knowledge gaps, Conroy now has new employees spend a month shadowing more experienced colleagues. She offers on-the-job training and has even considered adding in-house classes to get fresh hires up to speed. She’s held off on that, for now, because the costs of hiring instructors are high and she can’t afford to ask her already stretched staff to take time out for teaching.

There would be other ramifications if she and other employers start taking education into their own hands. It would create competition with local community colleges, many of which already struggle to fill their courses, and raise the question of whether employers are best suited to teach — a skill in its own right. 

Still, while Conroy would rather not take on that responsibility, she sometimes feels like she might not have a choice. 

“We’re not to the point where we’re hiring anybody off the street … yet,” she says. But, given how urgently the Bitterroot Valley needs medical assistants, “we’re this close to pressing the trigger.” 

This story was co-published by the Montana Free Press.

Open Campus national reporter covering the role of college in rural America.