We looked at a ton of qualitative and quantitative criteria to figure out where are the best 11 small cities for nurses in the US who owe a bunch in student loans. While many nurses graduate with $0 debt, some walk away with five or even six figures of negative net worth. In fact, our average nurse client has about $163,909 of student loan debt. You can listen how this kind of situation can happen on episode 4 of our Student Loan Planner podcast.
While there are a bunch of various student loan repayment assistance and forgiveness programs for nurses out there, the best one is Public Service Loan Forgiveness (PSLF). That’s particularly true if you owe more than your salary as a nurse. To qualify for PSLF, you must work full time for a cumulative total of 10 years at a not for profit or government employer. Many hospital systems qualify for this benefit.
If you don’t qualify for loan forgiveness as a nurse, you could refinance your nursing school debt and cut your rate. The only problem is that refinancing will likely be far less beneficial than PSLF if you owe a lot.
Hence, this list could look different if you were to look at the best cities for nurses with zero student debt. We chose our list with nurses who owe more than their income in mind.
Methodology for How We Ranked the Top States for Nursing
We pulled data from the Bureau of Labor Statistics OES Report published May 2017, which shows nurse’s average wages and employment data in various states. We sorted the chart too so that only the least saturated half of US states qualified. After all, if you have less competition in the labor force, you have more leverage with potential employers.
$70,000 is worth far more in Georgia than it is in Hawaii. That’s why we adjusted these incomes for cost of living. We did this by using data from the Tax Foundation, which shows you the value of $100 in every state based on reporting from the Bureau of Economic Analysis.
For example, in California the typical nurse earns $102,700. The value of $100 in California is $88.97. We multiplied $102,700 by .8897 to get the cost of living adjusted income for a nurse living in the state, and we came up with $91,372.
Out of the list of the 50% least saturated states, we ranked each state by this real nursing income number. For further filtering, we tested each state to see if it had at least one metro area that fit the criteria. If it didn’t, we moved on to the next state down the list. One thing that jumped out to me right away was how attractive the western half of the country is for nurses overall. That said, we found great small cities for nurses in every region.
Keep in mind the national nurses per 100k population average is 892, per BLS data. Each of these states is slightly above or well below the average (in a good way in terms of nurse incomes).
If you want to move to a city where you’ll have a lot of negotiating power, it helps if they’re hurting for more nurses. Here’s the list of 11 states after we filtered according to our methodology.
|States||Nurses Per |
|Real Nurse |
Qualitative Criteria for the Top 11 Small Cities for RNs with Big Student Loans
After coming up with our list of states, we decided to choose one city from each one of the most attractive states to be a nurse.
- Population is relatively stable or increasing
- Must have at least two non-profit healthcare employers with more than a couple hundred employees.
You want to be in a growing or stable area as a nurse. With a stable local economy, you probably won’t have to worry about healthcare systems closing.
The second criteria is not obvious why it would matter so much. That is, until you realize that most nurses with big student loan debt will want to work at a not for profit hospital because of the Public Service Loan Forgiveness (PSLF) program.
If there’s only one big hospital system in town, and that system gets bought out by a private group like HCA, you’re out of luck.
I received emails just weeks before writing this post from readers who are incredibly stressed out because of the Mission Health acquisition a few months ago in Asheville, NC. Many of them had purchased homes and put down roots thinking they could rely on Mission Health’s 501c3 non-profit status to help them get loan forgiveness.
When the main health system in town got converted to an ineligible for profit, the nurses were out of luck. Some are planning to leave the area, and others are coming up with alternative plans for their student loans.
In fact, in some of the communities I looked at for this study, I ran into cases of hospital consolidations that are eliminating loan forgiveness for nurses.
Hence, you want to make sure you have employment alternatives that also qualify for PSLF in this study that we did. It doesn’t hurt that when there are multiple employers to choose from, they’ll have to fight for the available nurses more than in a one hospital town.
If there were two big healthcare systems but only one was non-profit, we eliminated the city from contention simply because the risk would be too great for a nurse with monster student debt to lose her PSLF eligibility.
Quantitative Criteria for the Top 11 Small Cities for Nurses
To the descriptive rules, we applied a few quantitative screening tools as well.
- We used the rankings of per capita income provided by the Census Bureau for all MSAs (Metropolitan Statistical Areas) in the USA
- We screened for MSAs between 50,000 and 400,000 people (The idea is that you want to live in a city where housing costs aren’t through the roof but large enough where there’s more to do than just hang out at McDonald’s).
We chose the MSA with the highest per capita income in each state provided they had two non-profit healthcare employers for nurses and fit our population filtering requirements. Keep in mind when referring to a city, we’re referencing the MSA, which has larger population than the legal city limits. I used pictures of each city from the public domain on their Wikipedia pages. Any median earnings data is from the Census Occupational Employment Report from May 2017.
Our Top 11 Small Cities for Nursing List
Number 11: Fort Collins, Colorado
Fort Collins is exploding in population growth. UC Health system is very active in this outdoorsy city in fast growing north eastern Colorado. Banner Health also has a significant presence. Fort Collins might have one of the most developed beer scenes per capita in the country, with countless breweries. The Colorado Marathon also comes through Fort Collins every year. Median RN earnings are $68,560 in Fort Collins. To top it off, Rocky Mountain National Park and Denver are about an hour and a half away.
Number 10: Binghamton, New York
While median RN earnings are $60,440, your money is going to go a lot farther in Binghamton than in the Big Apple. Binghamton was were IBM got its start. The city experienced a downturn after the end of the Cold War, as many of the employers in the area had contracts tied to defense spending. The new economic focus is education and healthcare. Binghamton is even home to a famous sandwich, the Spiedie. The Binghamton Philharmonic, Tri-Cities Opera, and other cultural amenities will keep you busy. The two major healthcare systems center on Our Lady of Lourdes and Binghamton General Hospital. You won’t have to worry too much about getting a job here as a nurse.
Number 9: Athens, Georgia
Athens median RN earnings stand at $62,790. The city is eminently affordable as home to the University of Georgia main campus. It’s also a short drive away from Atlanta. On the employment front, you could work for St. Mary’s or Piedmont Regional Medical Center. Athens is becoming a major retirement destination for out of state transplants. I know this personally because my own in-laws are considering relocating there from the New York metro area. You also won’t need to compete with the college aged crowd for buying a house.
Number 8: Benton Harbor, Michigan
If you keep going west on I-94 past Kalamazoo, you’ll stop by the “Twin Cities” of Benton Harbor and St. Joseph on the shores of Lake Michigan. While there are a lot of little villages in the lakeshore community, the Niles-Benton Harbor MSA has over 154,000 people in it. Besides the obvious water oriented activities, you could drive down the road to South Bend, Indiana for a Notre Dame game. Benton Harbor is also less than 2 hours away from Chicago. You could work for either Bronson South Haven or Lakeland Health. The Census didn’t report median RN earnings, but it’s clear your money would go far here.
Number 7: Santa Fe, New Mexico
You could work for either the Presbyterian or Christus St. Vincent health system and enjoy the Georgia O’Keefe museum, beautiful aspen trees in the Sangre de Cristo mountains, and historic downtown on your off time. Most of us might know Santa Fe from the musicals Rent or Newsies. The city represents an escape and a new start in these shows. Median earnings of $68,390 aren’t too shabby either.
Number 6: Tyler, Texas
Tyler is a booming area an hour and a half southeast of Dallas. Though the $60,310 earnings are lower than some other cities on this list, recall that Texas does not have an income tax. If you like flowers, you’ll love Tyler, since it’s the “Rose Capital of the World.” It has the largest rose garden in the US (14 acres). You could work for either Trinity Mother Frances Health System or the UT Health-Tyler campus.
Number 5: Richland, Washington
You’ll notice a trend here. The cities at number 3, 4, 5, and 6 on this list all do not have an income tax at the state or local level. Richland, Washington is a few hours southeast of Seattle. It also happens to be the childhood home of my wife. You can go for a ride on the Sacagawea Heritage trail while following the Columbia River. There’s also lots of hiking with nearby Badger Mountain. There are several different healthcare employers, with Kadlec Regional Medical Center being the largest. You could also work for Seattle Children’s branch clinic or Lourdes Health. Richland is home to the Pacific Northwest National Laboratory. That kind of knowledge economy draw doesn’t hurt when you’re thinking about finding quality public schools for kids. The high median RN income of $72,470 without the high housing costs means more take home pay for you.
Number 4: Anchorage, Alaska
With incredibly high median RN earnings of $85,370, no state income tax, and the comforts of the biggest city in Alaska, Anchorage would make a fabulous home for many RNs. Both the Providence Alaska Medical Center and the Alaska Native Medical Center have a large statewide reach. Obviously, you’d have to deal with some cold winters, but if that doesn’t bother you then Anchorage could truly be an RN’s paradise. If you’re into the outdoors or hunting, there are opportunities all over the place in Alaska. If you’re a single heterosexual female, my friend from high school moved there and liked it a lot. She says there’s a fantastic male to female ratio.
Number 3: Reno, Nevada
The “Biggest Little City in the World” is rapidly growing in the healthcare space. We had physician friends who received absolutely massive offers to move there. As an RN, you could work at the Reno, VA or the Reno Regional Medical Center. Reno is a half days drive from San Francisco and Yosemite National Park, and it’s less than an hour from scenic Lake Tahoe. The 50th percentile of RNs in Reno earn $78,000. The top 10 percent earn just over six figures. There are a ton of entertainment options in town with all the casino resorts trying to draw in tourists.
Number 2: Medford, Oregon
Medford is right in between San Francisco and
Portland. You could get to either city pretty easily on a weekend trip by car. Medford’s economy is highly focused on healthcare. Providence Medford and Asante Rogue health systems are two of the biggest employers in the region. That makes sense since Medford is a popular retirement destination on the west coast. Median RN earnings sit at $83,600. Crater Lake National Park is a short drive away, and you’re pretty much surrounded by National Forests. Housing costs are way lower than most cities on the West Coast. If you want to make a lot of money in a hurry, move to Medford.
Number 1: Santa Barbara, California
Median RN earnings of $99,040 mean that it’s not at all unusual for a nurse in Santa Barbara to make six figures. Santa Barbara is has Stearns Wharf, a variety of downtown shops, and the UC Santa Barbara campus. While housing costs are pretty high, you could get creative with living in a smaller space to take home more of your higher pay. Santa Barbara has plenty of retirees, which means job security for nurses. The student population helps add some amenities that wouldn’t exist otherwise for younger folks. Retireby40 has a good guide for the myriad of things to do in Santa Barbara.
What Cities Do You Rank Tops for Registered Nurses?
Agree with our list? Think we made an omission?
Share what you think about our list of the top 11 small cities for nurses in the comments below!