Rural Americans say drug or opioid addiction is the most urgent health problem, according to a new poll. They are as concerned about opioid addiction in their communities as they are about local jobs and the economy, NPR reports.

“For many years, the opioid crisis was seen as affecting only a few states — West Virginia, Kentucky and New Hampshire among others. But it never was just about those states,” said poll co-director Robert J. Blendon, a professor of public health and health policy at Harvard. “It’s now at the same level of a very serious economic plight that people are really worried about. It affects elections, and it affects how people elected from rural areas view their priorities.”

The poll found 48 percent of rural Americans said the problem of opioid addiction in their local community has gotten worse, while 40 percent said it has remained about the same in the past five years.