Abstract Background The location dynamics of rural northern Minnesota involve shifting economic structures, demographic transitions, and diverse physical environments that affect access to Alzheimer’s Disease and Related Dementias (ADRD) diagnosis, care and health services. Method We conducted semi‐structured interviews with 56 key informants including health care providers (n = 7), health leaders and administrators (n = 10), social workers (n = 12), formal and informal caregivers (n = 19), and healthy older adults (n = 8) across northern Minnesota concerning the unique protective and risk factors and the socio‐cultural context of ADRD in the region. Interviews were transcribed and thematically coded in QSR NVivo using a lived experience framework. Result Our analysis reveals that winter weather, depopulation trends, and lack of healthcare facilities and services and aspects of rural culture create multi‐faceted challenges to healthy aging and ADRD diagnosis and care. Rural residents often rely on social capital, community institutions, volunteerism, and families to compensate for the lack of medical services. Rural people without social or financial resources may have to relocate to different communities to receive care and services. This lack of access to local care influences stigma and fear of dementia diagnoses in rural areas. These experiences shape cultural understandings of ADRD, and health seeking behaviors, which can be characterized as hesitant and dismissive, creating additional challenges for community interventions. Conclusion The location dynamics of rural northern Minnesota shape unique cultural understandings around ADRD diagnosis and care that limits the effectiveness of existing interventions and demands tailored approaches to overcome the lack of local resources, geographic distance, and winter weather constraints. Dense social networks, a culture of volunteerism, and community capacity to develop medical infrastructure are key assets used to overcome these challenges to ADRD care.