When Echo Warner’s uncle lost his hand in a farming accident on rural land by their mountainside home, the nearest facility lacked the skills and facilities to reattach it.

They sent him on the three-hour drive to Salt Lake, but by then it was too late.

For Echo, the fifth youngest of six children on a remote farm above Altamont in the Uintah Basin, this was just the way things were.

Hers was an isolated, difficult childhood. She relied on herself, her siblings, and exploring her mountain for entertainment. Everything was a 30-minute drive away, from childhood friends to the nearest hospital in Roosevelt.

She wanted to challenge the resignation she witnessed so often when people in her hometown discovered they had cancer and fatalistically shrugged, looking at it as something inevitable that God had decided for them. Then there was mistrust for local doctors. “They don’t understand us.” “They don’t know what our life is like,” she’d hear.

But she’d also seen the beauty in rural communities, like when a five-year-old girl two years below Echo in school was diagnosed with cancer. For years, Altamont fundraised to pay health care, travel, and food expenses for her and the family. It taught her that rural communities are bound both by blood and brotherhood.

“People like me who have been on food stamps and Medicaid haven’t been doing this kind of work before,” the 34-year-old says about her research on cancer, caregiving, and technology.

That’s because they don’t have the money, the social capital to navigate academia or health care, the ability to make friends having grown up alongside their friends since they were toddlers. And they have to overcome a natural instinct to silence their own voice for fear it will give them away as somehow rural, alien, other.

Echo learned early on that self-reliance and determination might just get her an education that rural folks rarely got to pursue. But even though she worked hard to get scholarships from Uintah companies and spent six years selling Old Navy gear, there were still days when she went hungry. Too proud to ask for help—“We rural folk don’t take handouts”—it was only her boyfriend, now husband, who kept her from homelessness. Through naïveté, a willingness to make mistakes, and the courage to trust her own voice in class, she became an assistant university professor.

What has driven her ardent grassroots advocacy for improving the lives of rural patients and their caregivers has been, in part, her need to give back to her hometown, to the people who believed in her and wanted to see her succeed, and to the people like them. But her success as a pioneer in her field has also been fueled by her deep knowledge of rural communities.

At the heart of Echo’s research are two questions: How can people feel cared for, even from hundreds of miles away? And how do we help every Utahn achieve their best health without uprooting them?

These questions came from the loneliness she found talking to cancer survivors and their relatives in her research. A woman in rural Utah whose husband was dying of a brain tumor told the 22-year-old researcher that what made her feel only more isolated was that no one would talk about it. In a small town already so remote, the discomfort around illness and death lent only more isolation.

“Talking about death and dying sounds a lot like giving up to many people,” Echo says. “And when everyone in town knows you and knows your partner, those conversations are really emotionally charged.”

Two years later and 5,500 miles away in Dominica, studying health beliefs in farming communities for her global health post-grad, Echo met a caregiver whose mother was receiving palliative care, who shared that same painful feeling of isolation.

Echo kept returning to those two conversations, so far apart and yet so similar. There had to be a solution.

It’s not just loneliness that can eat away at your soul as a caregiver. They need respite care and social support, Echo says, which is hard to find in rural areas. Even if it is available, being able to access it is complicated by lack of health insurance coverage and inadequate broadband internet, along with a deep stigma against seeking help from the government.

She found herself honing in on technology as a possible support.  One study Echo’s working on aims to develop microvideos that educate caregivers of pediatric patients with cancer about health insurance. In just a 5-minute video, caregivers better understood how to work with insurance, navigate financial burdens, and cope with the pressures of caregiving.

What it comes down to, Echo says, is recognizing that if you want to bring health care to rural America, you need to sit down with people on their porches, in their cafes and their schools, and talk to them as equals. She goes back when she can to Altamont to talk about cancer prevention, to research her former neighbors’ perspectives on cancer, and visits her old high school to encourage would-be scholars that a career in science really can be theirs.

One of Echo’s childhood friends, Baily Brinkerhoff, says the people from their hometown are proud “to say Echo comes from Altamont and she's a researcher at the University of Utah. That’s a big accomplishment.”

Growing up in a small rural town marks you deeply. “It always calls you back,” Baily says. “You're always called back home.”