Hidalgo County is one of the most extreme examples of how the coronavirus has shifted from dealing its heaviest blows to northeastern urban areas to now reaching all corners of the country. As the death count grows, smaller towns and rural communities bea

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When COVID-19 claimed its first 100,000 lives in the U.S., Hidalgo County, Texas, seemed to have avoided the worst of it. The county, which sits on the border with Mexico, had just 10 deaths when the U.S. crossed that tragic milestone on May 27.

But the U.S. has now doubled its death count to top 200,000 victims, and Hidalgo County has become one of the deadliest hot spots for COVID-19. Despite the lack of dense urban areas there — its largest city, McAllen, has fewer than 150,000 residents — the disease has killed more than 1,500 people across the county.

"We knew we were going to see an increase, but we could not foresee the increase we got," says Eduardo Olivarez, the chief administrative officer of the county health department.

Hidalgo County is one of the most extreme examples of how the coronavirus has shifted from dealing its heaviest blows to northeastern urban areas to now reaching all corners of the country. As the death count grows, smaller towns and rural communities bear a growing share of the burden of COVID-19.

An NPR analysis finds that the share of COVID-19 deaths outside places considered large metro areas by the Centers for Disease Control and Prevention has grown dramatically since the country passed its first 100,000 deaths. Then, about a fifth of deaths came from places outside large metro areas. In the second 100,000 deaths, that share jumped to nearly half.

The largest growth occurred in small towns and rural areas, where the share of deaths nearly tripled. ...