Audrey Thayer works with children and families in northern Minnesota who live on the edge of poverty. Many have income that falls below federal poverty guidelines.
As a result, there is a constant demand for services.
"We'll get one family up and running, and another family arrives," said Thayer, coordinator of the Minnesota Greater Racial Justice Project. "Same situation."
"It's almost like a revolving door," Thayer said of the Bemidji-based advocacy group's work. "Behind that door, there's tons out there. We don't know. We never know how many are going to come through that door, but they do. And in eight years, I have never seen that subside."
A new report by the Children's Defense Fund-Minnesota shows more children are living in poverty. In 2000, roughly 110,000 children statewide lived at or below the poverty line. In 2010, that number was up to nearly 200,000.
Kara Arzamendia, research director for the organization, said a combination of factors explains why more children are in poverty. Topping the list are the quality of jobs available for people, and the lack of jobs in general.
"In a lot of areas we've seen a deterioration of some of our public programs," she said. "There's some holes in the [safety] net that we've seen. And that's an issue, too, for families."
The federal government defines poverty as an annual income of roughly $23,000 for a family of four.
For children and families living in poverty outside the Twin Cities, there's a constant struggle between accessing services and the ability to afford them, Arzamendia said. That theme plays out in everything from putting food on the table to child care and health care.
"If they have the financial resources to access a service in their community, especially in rural areas where things are spread out [and] there's more isolation, they might not be able to access it," she said. "It might not be in existence. There might not be a grocery store or a health care clinic. And then there's the other piece, the affordability piece, where even if they could access in their community, for families that are struggling, living in poverty, they can't afford it."
Health care is one of the greatest struggles when it comes to families and children living in poverty outside the Twin Cities.
For example, last year 62 of Minnesota's 87 counties had a shortage of primary health care professionals. Almost every community outside of the Twin Cities had a shortage of mental health care workers.
The health care community has responded by encouraging professionals, including physicians' assistants, to work in rural areas, said Dr. Ray Christenson, assistant dean for rural health at the University of Minnesota Medical School.
"We're putting more and more physicians out," Christenson said. "I think if you go around the state you'll see that the practices are growing. There's nurse practitioners and PAs in those communities."
But rural communities are still underserved.
"I can't speak to the shortage," Christenson said. "Most of the surveys ... show that we're somewhere between 150 and 200 physicians short."
That means children who need the care aren't getting it.
Access to care is especially a problem for children who need mental health services, said Sara Dahlquist, a children, youth and family specialist for the Initiative Foundation, a nonprofit that helps rural residents with a host of services.
Recently Dahlquist worked on a federal mental health grant serving children in four central Minnesota counties: Stearns, Benton, Wright and Sherburne.
"Children were being identified in school, but then were not able to see a professional to either look at a care plan or medicine or talk therapy for six months," she said.
Dahlquist said those long delays can limit a child's learning and growth. The added stress of poverty only compounds the problem.