The Reality of Gun Violence in Rural North Carolina

Gun violence in rural NC

Rural Cleveland County, North Carolina. Gun violence is often thought of as an urban issue, but it's as much if not more so a problem in rural counties too. (Photo by Dylan Rhoney)

By Dylan Rhoney

October 25, 2023

Urban gun violence tends to get the headlines. But NC has a major gun problem lurking in its rural areas.

Roughly five people a day lose their lives to gun violence in North Carolina. Many of these victims are children, as gun violence is the leading cause of death in children aged 1-17 in the state. 

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While urban gun violence tends to get most of the headlines, the counties with the highest gun deaths per capita are all in rural areas. Vance, Robeson, and Graham Counties had the highest gun deaths per capita, while Wake County, the largest county in the state, had the lowest gun deaths per capita.

In fact, gun violence in the state’s rural communities occurs at a far higher rate than in its suburban and urban centers. From 2016-2020, the rate of gun murders in rural North Carolina was 76% higher than in urban areas. Furthermore, suicide rates in rural counties were double the rate of the states cities.


Tennessee State Rep. Justin Jones spoke at a protest in Raleigh last month, bringing to North Carolina the message he’s delivered over and over back home: Voters are rallying around the issue of gun safety and putting an end to gun violence. The rally took place a couple of weeks after several shootings and gun incidents on college campuses in North Carolina. #gunviolence #gunlaws #NCSupremeCourtJustice #ncrally #Northcarolina #nc #ncNews #Newsupdates #justinjones

♬ original sound – Cardinal & Pine – Cardinal & Pine

Legislative Solutions

There have been proposals recently to address gun violence, but many of these measures have not even received a vote in the Republican-controlled legislature.

One of these bills was House Bill 281, which was filed in March. The bill seeks to empower law enforcement to remove guns from a household where an individual is deemed a danger to themselves or others—otherwise known as a “red flag law.” The bill was sponsored by 29 House Democrats, but no Republicans have co-sponsored the bill and it has made no movement in the Rules Committee since it was filed there on March 7th of this year.

“We’ve got to give law enforcement the tools to protect people,” State Rep. Eric Ager of Buncombe County said.

Ager said that this bill would allow law enforcement to temporarily remove guns from a situation where a person is a danger to themselves or others, and prevent situations such as a mental health crisis from becoming more tragic.

“If there’s a crisis going on, that’s a great time to take those guns away, let things cool down in a way that will prevent people from doing things they really probably don’t want to do anyway,” Ager continued.

His colleague, Rep. Ashton Clemmons of Guilford County, also cosponsored the legislation, and said it could save lives. 

“If you have a loved one, or a friend, or a family member who you know owns a gun, and that you just see spiraling into suicidal thoughts or self harm, you can petition a judge to have the gun removed for just 10 days,” Clemmons said. “It’s not saying that this person should never have a gun, but it is saying that they are very likely to hurt themselves with their gun in this moment, and I don’t know why we would want someone at that moment to have access to such a lethal weapon.”

Clemmons also expressed concerns about the suicide rate in the state, particularly among young people.

“The statistic that keeps me awake is that one in five North Carolina high school students reported seriously considering committing suicide.”

Tragically, some of those students follow through.  In 2020, 67 children in North Carolina between the ages of 10-18 committed suicide, and 60% of those suicides involved a firearm. While only one-third of youth suicides occurred in rural counties, the rate that rural teens committed suicide was 1.8 times higher than urban and suburban youth.

While use of a firearm is not the only way a person could take their own life, it makes that choice easier, and could lead to a split second decision that cannot be reversed. In 2021, 70% of all suicides in North Carolina involved a firearm.

“When somebody is going through a crisis, not having access to guns isn’t going to solve all problems, but at least it would prevent some tragedies,” Ager said.

Instead of passing a red flag law, North Carolina Republicans made it even easier than it already was for people to get guns in the state.

In April, the General Assembly passed Senate Bill 41, which repealed the pistol permit requirement, which previously gave local sheriffs departments the ability to prevent people from buying a pistol if they were deemed unfit to own a weapon. The bill also included funding  to promote the voluntary safe storage of firearms, but did not require gun owners to adopt any safe storage protocols. 

The safe storage initiative was originally a stand alone bill that was supported by both Ager and Clemmons, along with several other Democrats. However, Ager says he believes it does very little to help solve gun violence. “I’m certainly supportive of that, but I don’t think it solves any big problems.”


An entire generation of students has grown up with school shootings as a fact of life — something Vice President Kamala Harris considers unacceptable. Speaking at event this week, she called out the “false choice” that some people push between passing gun-safety laws and defending the second amendment. #kamalaharris #vicepresident #gunviolenceawareness #gunviolenceneedstostop #awareness #northcarolina #gunviolencepreventiion #gunsafety #gunlaws #genz

♬ original sound – Cardinal & Pine – Cardinal & Pine

Proximity to Hospitals and Mental Health Services in Rural North Carolina

Another challenge facing rural North Carolina  is the distance between many communities and hospitals. Twenty of North Carolina’s rural counties  do not even have a hospital, and 35 do not have an ICU bed. 

This means that some rural victims of gun violence may be unable to get to a hospital in time for potentially life-saving treatment.  Ida Powell, who worked as an ER nurse in Alamance County and now resides in Eastern North Carolina, says it can be challenging for rural residents to get to a hospital. 

“You might not be far distance wise, or as far as the crow flies, but if you’re on country roads in the middle of the night, you’re a ways away,” Powell said.

She also said that some smaller hospitals may not be equipped to handle injuries due to gun violence. “Sometimes they need to get a patient to help, and it doesn’t matter if it’s a trauma center or not, you have to go where there’s a blood bank and you can provide blood products and sometimes that’s at the smaller hospital on the way to the bigger one.”

“There’s not a trauma surgeon on call 24/7 at the smaller hospitals.”

Powell also expressed concern that some smaller hospitals are not equipped to deal with the potential fallout from a school shooting or mass shooting.

“The smaller hospitals also don’t have all the same equipment—especially when it comes to pediatric patients—that a trauma center does,” she said. “There are things that we would use frequently with gunshot wound patients, like a rapid infuser, which provides blood products and fluids to a patient more quickly than a normal IV pump or just using gravity to infuse. The smaller hospitals I worked at either didn’t have those or had one. So if you had more than one patient coming… I guess you choose.”

Erin Lynch, a preschool teacher in Wilson County echoed conerns that her community would not be able to handle a mass shooting or shooting with multiple victims. 

“If it involved children, whether it be a mass shooting or a home incident, I would be so scared that our medical infrastructure and pediatric services would not be able to handle it,” Lynch said. 

Lynch also does not believe the community has adequate mental health resources. “I know that Wilson does not have the medical infrastructure to deal with people seeking mental health counseling and psychiatric services.”

One source of support for mental health services could come in the form of Medicaid expansion, which will take effect in early December. The expansion is expected to expand health insurance, including mental health coverage, to an estimated 600,000 low-income North Caorlinians—including many rural residents—and help prevent more rural hospitals from closing. The expansion also comes with an increase in funding for mental healthcare services using a one-time federal “bonus,” passed as part of President Joe Biden’s American Rescue Plan in 2021 in an effort to incentivize states to expand Medicaid

The General Assembly directed $20 million in bonuses and incentive pay for workers in the state’s psychiatric hospitals and boostedreimbursement rates paid to mental health and substance use service providers over the next two years. 

However, as Clemmons notes, this funding “bonus” is temporary.

“There is a significant increase in funding,” Clemmons said. “It is not state funding, and it is one-time [federal] funding, so that’s not going to be a long-term solution, but hopefully it can help us get on the right path.”




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