The importance of strong, sustainable annual funding for the National Institutes of Health (NIH) is known to states with major biomedical R&D hubs like California, Massachusetts, North Carolina and Texas. In these states there is a clear link between the NIH-funded research that occurs there and the state’s economy and job creation. But what about states where such a link might be less apparent? What is the impact in states that tend to be more rural than urban and that aren’t among the top recipients of NIH research funding?