Gary and Celeste Havener live forty miles outside of Laramie in southeast Wyoming. They spend a lot of their time growing vegetables and riding horses across the prairie.
"And anytime you get on a horse, anything can happen," said Gary.
A few weeks ago, his wife, Celeste fell off her horse.
"[I] had a very ungraceful dismount and tweaked my knee pretty good," Celeste said.
Afterwards, she laid on the ground for a while, trying to figure out how hurt she was. But she was also wondering if a visit to the doctor was worth it.
"After it didn't get better, I did go to town," she said.
This kind of decision making is something she and her husband do often, since they both have other health issues. Gary deals with pain from injuries working as a carpenter. And Celeste just recently wrapped up radiation treatment for breast cancer.
"I think most rural people choose doctor denial as their first choice," said Celeste. "Doctor Google is their second choice."
In a recent poll by NPR, the Harvard T.H. Chan School of Public Health, and the Robert Wood Johnson Foundation, 26 percent of rural Americans said there has been a time in the past few years when they needed health care, but did not get it. A majority of them say it was because financial barriers kept them from seeing a doctor. But almost a quarter of them said it was because health care was too far or difficult to get to.
"In a rural area, if someone can manage their own health better and go to the doctor less often, then that's a win for everybody," said Janet Korpela. She works for a program in Wyoming called "Healthy U."
She recently ran a workshop with volunteers for the program. The volunteers from that training will go back into their communities to teach patients living with chronic conditions how to better manage their health. These leaders don't need a medical background. Korpela said they just need to be willing to do the forty hours of free training.
"This curriculum is really designed to be led by peer leaders, which means that the leaders should be equivalent or equal to the people who will eventually be taking the workshops," she explained.
Anna D'Hooge is one of 62 leaders trained in Wyoming.
"I think we tend to think of it [chronic conditions] as a medical issue in the sense of disease management, like you just need to go to the doctor or take your medication," she said.
She's a nutritionist at a hospital in Cheyenne, and the majority of her patients deal with a chronic condition.
"Hopefully people will realize that 'Oh, well I'm not a healthcare doctor, I'm not a nurse, but I do have these skills so I can help my friend with a chronic disease by doing this,'" she said.
For D'Hooge, she decided to do the training as a way to make her community a healthier place to live.