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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Small Towns are GOLD!

small town in the countryside

Having trouble finding a location for your niche practice? Or trying to figure out where to market your telemedicine practice? Then seriously consider SMALL TOWNS! They can be gold mines in terms of cash-based niche practices!

I have discussed this multiple times in the podcasts. Multiple podcast episodes have been with nurse practitioners opening SUCCESSFUL practices in smaller towns. So, be sure to listen to the podcasts if you want to hear true stories about successful practices in small towns. But let’s get to the article today.

I am dead serious about this concept. I have known dozens of nurse practitioners who have started niche cash-based practices in small towns and have had great success. Even the clinics I own are considered to be in “smaller cities” of less than 120,000 people! But you can even have success in towns of 5,000 people! Why? The answer is simple:


That’s right… you would be the only show in town. And guess what? People are people… it doesn’t matter if your patients are in large cities or small towns: they want these services! Therefore, the demand will be there ESPECIALLY if no one else is doing it!

Now, many of you might be thinking “I don’t want to drive 1-2 hours to a clinic in a small town.” And my answer to that is “Don’t you want to have a successful business?”

Listen, a lot of the niche services we teach in our courses are saturated in larger cities and areas with a high population density (usually… but there are exceptions which is why you need to do some basic market research before opening or expanding your current business.). But the smaller, less densely populated areas are there for the taking because no one else is providing services there! So, it is worthwhile to consider this concept.

I drive 2 hours away to perform medical cannabis card evaluations twice a month in a po-dunk town. Why? Because no one else is performing medical cannabis card evaluations in a 2-hour radius around that town. I am the only show in town, and I kill it those 2 days a month.

My second men’s health practice is in a city of about 70,000 people and we are doing quite well also.

I have talked with nurse practitioners who are in towns of 10,000 people and they have a SIX FIGURE monthly income generating practice. That is right… They make $100,000 a month in a town of 10,000 people. Read this concept to understand how: you only need 100 patients.

The reason why small towns are so lucrative is because the demand is there and there is no competition. It is as simple as that.

So, what are some things you should consider if you want to implement this strategy? Let’s go over them:

  1. How far do you want to drive? In my opinion, something that is 1-2 hours away is generally worthwhile if it becomes successful (and it will if there is no competition). Remember, if you follow the steps in the courses and create your practice as a “side hustle” at first, then you should only be working there 1-2 days a week. So, the drive isn’t that big of a deal. But if it becomes busier, then you could consider staying at a hotel/AirBNB one to two nights a week as you work. Or just move there!
  2. Are there locations to rent in the small town? You obviously need to check if there are retail and medical spaces for lease in the town. Some towns might have very limited supply of commercial real estate, so be sure to do your research here! And remember, if it is on the main street through town, the better!
  3. Is there any competition? This is a critical question that you can discover by doing some basic market research. One of the whole points of starting a practice in a small town is because there is no competition there! Therefore, you need to do your research and ensure you will be the only party in town!
  4. Could you just market your telemedicine practice there heavily? If you are hesitant about starting a brick and mortar practice, cautious about expanding your current practice location to another town, or simply looking to grow a telemedicine practice, then marketing heavily in the digital space within the small town could pay big dividends! The beautiful thing about digital marketing is that you can target specific areas, including towns! So, this could prove to be a powerful strategy for those more in the telemedicine space.

Those are some of the biggest considerations you need to ponder on if you are going to decide to start a practice in a small town or expand your current practice to one.

I am telling you guys, small town America is an absolute gold mine for niche practices! Every time I hear a nurse practitioners limiting beliefs about “there is too much competition in my area” when it comes to starting a niche practice, I just shake my head… Don’t let some minor inconveniences and speed bumps prevent you from building a life of financial security and professional freedom! There are still LOTS of opportunities out there folks! And the rural and smaller towns are one of the greatest opportunities for the astute nurse practitioner entrepreneur in my opinion.

Oh, and if you already live in a small town, then GET STARTED BEFORE SOMEONE ELSE DOES! Seriously, if you live in a small town already, then you need to look around and determine what the need is and DELIVER IT! That is one of the keys to building a profitable and successful practice.

4 Responses

  1. Your optimism is infectious. I’m trying to start the NP house calls for Medicare, but decided to work for Optum via Staffing agency for sometime, to feel it out first. If working for Optum does not work out, I will still do it. What other side hustle do you think can pair nicely with it?

    Thanks Stella Duru FNP

    1. Stella,

      Well that is going to be an insurance based practice… So there isn’t much else you can do with it outside of primary care.

      My advice would be to start a separate business that is cash based. Weight loss, HRT, IV infusion, and functional medicine based services are typically a SAFE BET if there is little competition.

  2. Hi! I have been following you for a while. I am a Fnp and just finished my Pmhnp. I live in a small town about 12,000. I am interested in the Hrt. I plan on taking your courses to get started. My question is I want to cash pay. My concern is most people are low income and I am afraid it wouldn’t be successful. There isn’t anything like this offered within a 45 min to 1hr 40 min drive. Also do I just start with Hrt and add another service later or offer a couple services? If so, what do you recommend? I plan on keeping my full time job and hopefully going part time eventually. Thanks for all your insight.

    1. Teresa,

      Guess what? My first men’s health practice is in one of the poorest counties in the country and we are killing it. People told me a cash based practice would never succeed… well I proved them wrong. PEOPLE HAVE CASH. Don’t worry about that.

      HRT and weight loss would be a great start! Then you can add on other things later.

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