During the Covid-19 pandemic, as the nation has grappled with health and financial crises, many people across the country have seen their debts rise and their ability to pay them fall.

As businesses cut back or closed, workers not only saw their income decline or disappear but also lost their medical insurance coverage. A Lending Tree survey published this March found that 60% of Americans were facing medical debt, with the amount exceeding $5,000 for 53% of them. (Click here to see how many people in your state are burdened with medical debt.)

But debt was already growing before the pandemic hit. In March, the Consumer Financial Protection Bureau and the Federal Trade Commission jointly released a report saying that U.S. consumer debt had risen to a record $14.3 trillion in the first quarter of 2020.

Overdue debts are frequently referred to collection agencies. The Urban Institute considers debt in collections “to include debt accounts (e.g., credit cards) that were previously more than 180 days past due and have been closed and charged off,” as well as unpaid student and car loans, medical and utility bills, parking tickets, child support payments, and membership fees that have been referred to a credit bureau. 

Click here to see the counties where the most people have debt in collections.

To identify the counties where people are struggling the most in debt, 24/7 Wall St. reviewed data from the “Debt in America 2021” report, based on credit bureau information from 2020, published by the non-profit think tank the Urban Institute.  

Debt collectors can be notoriously aggressive — and new rules from the Consumer Financial Protection Bureau will allow them, beginning at the end of November, to contact debtors via direct messages or friend requests on social media. (However, they will be prohibited from communicating on social media in a way that can be seen by the public.)

  Individuals in some parts of the country have more debt in collections than in others. Sometimes the differences are dramatic. McKenzie County, North Dakota, for instance, tops the list with a median amount of $4,972 in collections. (Here are the worst counties to live in.)