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Rural America has a growing suicide problem.

Suicide rates in rural America are steadily increasing, according to a report out Wednesday from Governing magazine:

The aggregate suicide rate for counties outside of metropolitan areas climbed about 14 percent over the five-year period ending in 2016. By comparison, the rate within metro areas also increased—but only by 8 percent. The largest metro areas, in particular, experienced relatively small increases compared to everywhere else.

The suicide rate is highest in the Western U.S., with Montana (26 deaths per 100,000), Alaska (25.4 deaths per 100,000) and Wyoming (25.2 deaths per 100,000) recording the highest rates. Rates were about three times lower in the more urban states of Massachusetts, New Jersey and New York.

Governing reports that no one factor contributed to the increase. Instead, it’s a complicated mix: Gun ownership is a significant predictor for an eventual suicide. So too are the psychological consequences of a life spent in poverty. And while “rural America” tends to be code for “white America,” rural communities are far, far from being monolithically white. Racial discrimination also contributes to rural suicide rates:

Among Alaska’s indigenous villages, Eric Morrison of the council says a loss of culture or language, as well as the trauma associated with decades of colonization, may also be affecting older natives and their descendants. “The web of causality differs from place to place,” he says. “If there was one simple answer, we would have solved this years ago.”

Previous research already showed a widening economic gap between rural and urban America. With suicide rates mapping similar disparities, the chasm between the two is set to become deeply entrenched.