Dr. Mehmet Oz is pitching a controversial fix for America's rural health care crisis: artificial intelligence.

"There's no question about it — whether you want it or not — the best way to help some of these communities is gonna be AI-based avatars," Oz, the head of the Centers for Medicare and Medicaid Services, said recently at an event focused on addiction and mental health hosted by Action for Progress, a coalition aimed at improving behavioral health care. He said AI could multiply the reach of doctors fivefold — or more — without burning them out.

The AI proposal is part of the Trump administration's $50 billion plan to modernize health care in rural communities. That includes deploying tools such as digital avatars to conduct basic medical interviews, robotic systems for remote diagnostics, and drones to deliver medication where pharmacies don't exist.

Oz even suggested replacing in-person obstetric care with AI-guided devices.

"We can use robots to do ultrasounds on pregnant women," Oz said. "You take a wand, you don't even see the image—you just get digitized insights that tell you whether the child's OK. And frankly, I don't have to see the image. I just have to know if the image is good enough to tell me the child doesn't have a problem." 

In a statement to NPR, the Centers for Medicare and Medicaid Services said Oz was emphasizing the need to "responsibly explore tools" that can extend the reach of licensed clinicians, not replace them altogether. It also said that CMS supports the use of AI-enabled tools when they are evidence-based, patient-centered and used appropriately under clinical oversight. 

What rural America is already facing

Oz's comments came as rural hospitals have faced steep cuts under the One Big Beautiful Bill Act that President Trump signed last year, a reconciliation law that cuts federal Medicaid spending by about $1 trillion dollars over 10 years, heavily impacting rural hospitals.

These hospitals already had been grappling with financial pressures. According to the nonpartisan research organization KFF, more than 190 rural hospitals have shut down between 2005 and early 2024 — about 10% of all rural hospitals in the country — because of budget shortfalls and related challenges. Some communities have lost their only hospital, leaving residents having to drive long distances for basic and emergency medical treatment — or skip it altogether.

Across the United States, people living in rural counties are more likely to die early from five leading causes — heart disease, cancer, chronic lower respiratory disease, stroke and unintentional injuries — than those in urban areas, according to a report published by the Centers for Disease Control and Prevention in 2024. Many of those deaths are preventable with timely, quality care, according to the report.

The CDC research pointed to several culprits: limited access to providers, longer travel times, fewer emergency services, higher poverty rates and lower insurance coverage.

A health care system with fewer people?

Carrie Henning-Smith, associate professor at the University of Minnesota and co-director of its Rural Health Research Center, says the use of AI avatars would strip away something essential: human connection.

"Health care has always been about humanity and relationship," she said. "If your first and only provider is an avatar, we're removing trust, comfort, and continuity."

Henning-Smith also raised concerns about testing unproven technology on already underserved populations.

"I don't like the idea of rural populations being treated as guinea pigs," she said. "If this is where we're testing AI in health care, there's a lot that could go wrong."

She also pointed to logistical concerns such as unreliable broadband, low health literacy and fragile transportation systems. If AI systems can't function without a stable digital backbone, she said, they could deepen existing gaps.

Supporters say AI could help expand access

But some health tech leaders argue that AI tools could help rural communities — not by replacing doctors, but by taking on administrative burdens that keep clinicians from seeing patients.

Matt Faustman is the co-founder and CEO of Honey Health, a company that develops AI tools designed to automate tasks for providers — including managing fax inboxes, processing prior authorizations and retrieving patient records.

Many providers are overwhelmed by paperwork, Faustman said, and the burden is especially heavy in rural settings where clinics may not have large administrative teams.

"Thirty to forty percent of physician or provider time can really get absorbed with administrative work," he said.

Faustman said automating those tasks could free up clinicians to focus on patient care — and allow small hospitals and clinics to scale faster without hiring more back-office staffing.

He also said AI could play a role on the patient-facing side, especially in areas where the right provider is not immediately available.

"It can serve as an initial triage or even an early access opportunity for those patients to then get diverted to the right providers," he said.

Can AI really replicate a human clinician?

Henning-Smith argues that even if AI tools can handle basic tasks, they can't replicate the core of what health care requires.

"AI can't read facial expressions, tone of voice, or body language," she said. "And those things matter. That's where the relationship between a patient and provider is built — in the nuance."

Even when AI tools are accurate, she said, they can't offer the reassurance or cultural sensitivity that comes from a trusted clinician. And in communities where trust in the medical system is already fragile, that loss could be especially damaging.

Henning-Smith also raised concerns about the economic consequences of replacing local jobs with AI technology.

"When a nurse or doctor is employed in a rural town, their salary stays there," she said. "But when you replace that job with an AI tool built in Silicon Valley, that money leaves."

Public backlash

Online reaction to Oz's comments was swift.

 "You think rural communities want AI doctors? They're still trying to get reliable internet," one user wrote on X.

 Another added, "Dr. Oz: 'We replaced your nurse with a cartoon. You're welcome.'"

Still, a few voices defended the idea, noting that some care is better than no care at all.

"It's not ideal," one post read, "but it's better than nothing."
 
Oz has not offered a full implementation plan, and CMS has not confirmed whether AI avatars will become a formal part of the agency's rural health strategy.

But Henning-Smith hopes the conversation doesn't end with cost savings.

"I'd be curious if Dr. Oz would want an avatar treating his own family," she said. "This feels like a two-tiered system — one for those with resources, and another for those without. And I don't think we should be okay with that."