What If Great Minds Fled the City?

Just over six years ago, my younger brother Cory wrote me a touching email. After hardly having seen nor heard from him for several years, I was surprised to find in my inbox a lengthy, thoughtful update on his life. (We had not been on the most cordial of speaking terms prior to that due to conflicts related to his drug addiction.) In his message, he spoke about his recent move from the mountains of rural Appalachia to Austin, Texas. In Austin he had finally found a community that was instrumental in his addiction recovery. By volunteering at local public charities, faithfully attending a dance community and altering his work ethic to be less hurried and more deliberate, he was able to see the importance of “the greater good” over the importance of the “temporal indulgence” of his addiction.

In spite of his general contentment, however, he expressed to me some regret over finding his niche in such a large city.

As he wrote:

“The only down side to [Austin] whatsoever is that its population is largely made up of young intelligent individuals that all came from somewhere that likely needs them. The “brain drain” effect to the max. There are so many amazing people here reciprocating energy off each other, I can’t help but think about all the small towns that are missing that source of personality and income… “

I read these words from the computer lab at my medical school in the largest city in the US, New York City. I was taking a study break from neuropathology. As a second-year medical student, I was spending twelve to fourteen hours at the medical school building on East 69th street. What little remained of my waking hours was spent walking to and from my apartment on East 77th street. Looking out the window at the busy intersection of East 69th street and York-one filled with fast-walking pedestrians to and from the buildings in the New York Presbyterian and Memorial Sloan Kettering medical centers-I wondered how our society would look if all the well-paying jobs in the economy were in rural areas.

Imagining this hypothetical scenario, I began a thought experiment that I still repeat from time to time to this day.

What if the economic growth over the past 200 years went in the direction not of urbanization but of ruralization?

In the 1800’s, well over 90% of the US population lived in rural areas. In 1900, that number had dropped to 70%. Today, a paltry 19% of the US lives in a rural area. What if the statistics were reversed? What if 20% of the US lived in cities while 80% lived in the country?

Now, before I advance to far into this status-quo questioning line of thought, I want to declare first and foremost that I don’t hate, or even lament, the existence of cities. I’ve lived in New York City, Boston, London, Madrid, and Houston, and I’ve found a special fondness for every one of them. I loved being able to get up and walk down the street to national conferences while living in New York City and in Boston. In Madrid, I adored the Cercanías train that could get me from Madrid’s Barajas airport to my wife’s apartment near ‘Nuevos Minesterios’ metro stop within half an hour, allowing me to commute every week from my doorstep near Brussels to her doorstep in Madrid within a few hours. I love the cultural, social and economic riches that cities have to offer.
Back to the thought experiment.

If we imagine the rural/urban ratio of present day urban society being not 20% rural: 80% urban but rather 80% rural: 20% urban, the current-day countries that would fit the bill would be ones like Swaziland, Malawi, or South Sudan-countries which have not enjoyed even close to the amount of economic growth as Western countries have over the past two centuries. The accompanying growth of economic standards of living alongside urbanization could imply on the one hand that urbanization leads to economic growth. So has been the argument-urbanization leads to efficiency, economies of scale, economic growth, etc. This trend could also imply that the urbanization and economic growth are simply correlative trends and that one does not necessarily lead to the other.

If we could put historical blinders on-which I know is not entirely possible-would it be possible just for a moment to envision a society with the economic standard of, say, Switzerland (GDP per capita $84,000/year) while still maintaining a rural: urban ratio of 80% rural to 20% urban?
Many would say ‘absolutely not,’ but if we think for a second about essential economic services that are associated with urbanization could just as well be supplied in a rural-based economy.

Take food production to start. The vast majority of Americans’ food supply could theoretically be supplied by home gardening. Many homesteads have been able to supply their entire year’s supply of food with just a half-acre lot on which to grow vegetables and raise livestock. When specialized foods are needed, many can be acquired locally or even bartered for. And when families suffer from poor harvest, famine or pests, those with abundance could support those with less harvest through community pantries-on a local level-or inter-region food-sharing agreements on a larger scale.

Electricity, as well, could theoretically be supplied to a large population in a rural-based economy. Solar panels (especially with advances in production), hydroelectric energy, wind energy and simple conservation-from not keeping large urban office buildings running-could supply much of people’s needed electricity. And when fossil fuels are needed, there is nothing preventing power plants from supplying people’s power in rural areas.

As well, transportation can be made nearly as accessible in urban areas as it can be in rural settings. Cars of course have been the ‘staple’ of rural families in this country, but that doesn’t have to be so. If more people paid for trains to go to rural areas (as in France and much of the rest of Western Europe), a flourishing, extensive train network could transport people between rural cities for much less energy than cars could. As well, even air travel could be made extremely accessible to rural areas by either self-piloting or cooperative ownership of planes, where groups of families share ownership of planes. Many Alaskans manage to live hundreds of miles from the nearest city by flying their own planes.

Finally, quality healthcare could, I would argue, be delivered in a rural-based economy. Country doctors (general practitioners) could supply the lion’s share of medical care, and when more specialized care is necessary, much of it could be handled through e-consults online (as is increasingly the case in rural settings). Many lab tests can be performed on a patient thousands of miles away, and imaging could be read by read by a radiologist from virtually anywhere. Though as much as 80% of people’s medical needs could be met in a primary care setting, certainly there are cases where a person needs a surgery from a far-off surgeon or a drug infusion from a special cancer center. But-with a robust train system, flying cooperative or personal aircraft-a patient could just as well travel a thousand miles in a day. And for the emergent procedures, there are ways to adapt to rural settings (e.g. ambulances with CT scanners and clot-busting agents for strokes).

I will stop my thought experiment here. I have said nothing of entertainment, sports, or education in a rural-based economy, though I think that they can all be made accessible to most people in the scenario I’ve just described. That will be for another post.

My point is not to make a Luddite case against modern technology-which I very much appreciate-but to raise the question of whether the state of urbanization that we’ve reached in the West needs to be the status quo.


After reading my brother’s message, I took an extended break from my studies to compose a reply. I thanked him for writing and encouraged him to continue in his community service endeavors that helped him “climb one rock higher” over his addiction. I also proposed that he and I take a trip together, to reconnect after years of disconnect wrought by addiction. He replied quickly, saying that “he wouldn’t miss” the opportunity to spend much-needed time together. He unfortunately suffered a bike accident after that, after which he relapsed and ended up in prison. Several years later, though, we were finally able to make that trip together. After over a decade of estrangement, we walked the Primitive Way of Saint James, reconnecting in the mountains of Asturias-hours away form any city.