It may have taken a little bit longer to appear, but since the coronavirus began reaching rural areas, there has been no stopping it. Now, though, research shows that these communities are showing reluctance with their best defense against the disease — COVID-19 vaccines.

“Rural residents are among the most vaccine-hesitant groups,” wrote Ashley Kirzinger, Cailey Muñana, and Mollyann Brodie of the Kaiser Family Foundation, a national health information organization, in summarizing the first results of their COVID-19 Vaccine Monitor.

The Vaccine Monitor surveys and focus groups found that just 31% of rural Americans said they will “definitely get” the vaccine, compared to over 40% of urban and suburban residents. Conversely, one in five rural citizens said they would “definitely not get” a vaccine even if one was safe, free, and available.

Further, 38% of rural Americans said that once a vaccine is available to them, they will probably wait to receive it to see how it works for others.

In addition to rural residents, demographics most likely to be skeptical of the vaccines were Republicans, people 30 to 49 years old, and African American adults. Yet the researchers found that even when those factors were controlled for, rural residents were still more likely be hesitant.

This doubt seems to be fueled by attitudes about the disease, the survey suggests.

Though rural residents are just as likely as urban and suburban Americans to know someone who has had COVID-19 or even died from it, 39% of rural citizens are not worried about themselves or someone in their family contracting the virus. Less than one quarter of urban residents were that unconcerned.

Rural residents were also by far the most likely (62%) to say that getting vaccinated is more of a personal choice. On the other side, the majority of urban residents and nearly half of suburban Americans view receiving the vaccine as a responsibility to protect the health of others.