While the overprescribing of opioid-based painkillers may be the main driver of the increased abuse of opioids in rural America, it may be more complex than that. Economists say that other factors, including declining farm income, extreme weather and other natural disasters, may affect a crisis that is killing thousands of citizens and costing the country billions of dollars.

Attracting college graduates and improving natural amenities -- parks, hiking trails, cleaner air -- can combine to boost economic growth. Penn State researchers suggest the factors may reinforce each other -- a clean environment attracts college grads who want to improve the environment.