New York (CNN Business) As the United States nears its longest economic expansion on record , it's tempting to proclaim that all the problems brought about by the Great Recession have been fixed.

That would be wrong.

Despite the currently healthy economic figures, from unemployment to foreclosure rates , under the surface the country still bears bruises from the financial crisis. Some of them may never heal without a targeted treatment plan.

Here's what's still ailing America after ten years on the mend.

1. Wins for big cities, losses for small towns

The recession and its aftermath shifted the geography of prosperity in America — and workers still haven't caught up.

Manufacturing employment, which had been in decline since the 1980s, dropped suddenly between 2007 and 2009 as factories failed. That left towns in Michigan, Ohio and upstate New York gasping. "Those places were hit harder by the recession and are slower to recover than the national average," said Dave Swenson, an economics professor at Iowa State University.

In a double whammy for residents of declining towns, the places where new opportunities arose — bigger cities like San Francisco and New York — didn't add nearly enough apartments after the housing crisis to keep up with demand. Wage gains in big cities have concentrated at the top , so even if you found a mid-skill job serving the tech or financial industries, moving to take that job was financially impossible.

"The cost of living in core metro areas has just become prohibitive," Swenson said. "It's slowed some of that migration into the most urban areas."

2. State budgets atrophied

State and local tax revenues took a massive hit during the recession and were only partially backfilled by federal grants, forcing widespread layoffs that weakened all manner of public services. On the surface, according to the Pew Charitable Trusts , tax collections have recovered — in 2018, revenues across all 50 states exceeded their 2008 levels by 13.4%.

However, states have also had to cope with rising costs, particularly for Medicaid. That's made it more difficult to allocate funds for other priorities. State spending on infrastructure as a share of gross domestic product is as low as it's been in 50 years, Pew found, and state governments have 132,300 fewer non-education employees than they did in 2008.

Funding for schools also remains short. Twenty-nine states are now spending less per K-12 pupil than they did in 2008, and state spending on higher education is 13% lower, as public universities have shifted the tuition burden on to students — which, one study found , reduced degree attainment among both graduates and undergraduates.

3. The mixed blessing of low interest rates

To keep money circulating after the financial crisis, the Federal Reserve cut short-term interest rates to near zero in late 2008 and didn't start raising them until 2015 . That unprecedented action, along with several rounds of bond purchases known as quantitative easing, pushed cash into the economy and fueled an epic stock market recovery.

But just like taking painkillers for too long can have side effects, the Fed's monetary policy remedy gave rise to some unintended consequences. For example, low bond yields led the big funds that control trillions in investment to put their money into private equity and hedge funds that paid high rates. As a result, initial public offerings, which allow a wider group of people to benefit from the creation of new businesses, virtually dried up.

Meanwhile, low interest rates have been bad news for pension funds, which mostly depend on bond yields in order to remain solvent. Public pensions' assets amounted to just 66% of their liabilities in 2016, down from 86% in 2007, according to the Pew Charitable Trusts . For the 100 largest private pensions, that ratio was 87.1% in 2018, according to the actuarial firm Milliman, compared to 105.7% in 2007.

For retirees counting on fixed-income securities like government bonds, low interest rates can also mean a lower standard of living.

"Low interest rates, while they have a lot of benefits, have a lot of costs for society as well," said Kevin Kliesen, an economist at the Federal Reserve Bank of St. Louis.

And that's just short-term rates, which the Fed controls directly. Long-term interest rates were in decline before the financial crisis, and the ensuing recession depressed them even further; Fed officials are now struggling to nudge inflation up to their 2% target.

Those low interest rates may be sapping the economy of its vitality. One study published this year found that they give larger firms a greater incentive to invest than smaller ones. That fuels market concentration and reduces business dynamism — that is, the ability of startups to disrupt incumbents.

"As interest rates go down, they disproportionately favor market leaders as opposed to market followers," said Atif Mian, a finance professor at Princeton University who coauthored the study. That effect, he found, "is large enough for low interest rates to not have any expansionary effect on the economy any more."

4. A hobbled generation

In any downturn, the worst-hit group is the one just starting out.

A study published this year by economists at Stanford and the University of California-Los Angeles found that people entering the labor market during recessions have lower lifetime earnings, especially if they have only a high school education. They also have higher death rates in mid life.

The Great Recession, which was unusually deep and prolonged, is having a lasting effect on young people who graduated from college in 2010 and 2011. Employment and earnings are lower among those classes, found University of California-Berkeley economist Jesse Rothstein.

As they move on to the age when previous generations bought houses and had kids, those markers of adulthood are less attainable, and not because Millennials don't want them. Rather, t he Federal Reserve found , they have fewer assets to work with — and higher student debt.

5. The shadow of fear

However persistent the financial effects of the recession may be, the psychological effects fade even more slowly.

People who lived through times of high local and national unemployment spend less money and use more coupons than those who weren't personally affected, even if they earn the same amount, a 2018 study by researchers at the University of California-Berkeley found. The recession also caused an increase in suicides , especially in rural areas and among women.

worse off than they were before the economy collapsed. That sentiment, however, isn't purely dependent on material well-being. A study Americans' perceptions of their own financial situations have been slow to recover. In a survey by Bankrate, 23% of respondents said they wereworse off than they were before the economy collapsed. That sentiment, however, isn't purely dependent on material well-being. A study published in the journal "PLOS One " found that the psychological pain of a financial loss is greater than the psychic benefit of an equivalent gain.

"Since the recession, there has been more of a disconnect between peoples' perceptions and their actual economic conditions," said Dana Glei, a Georgetown University sociologist who co-authored that study.

Glei thinks that may have had to do with the spread of social media, which allows people to compare themselves to people who appear to be in better financial shape. And it probably exacerbates the political division already fomented by rising income inequality, when people find someone to blame for their adverse economic fortunes.

"It raises issues of status anxiety," Glei says. "People are cutting in line, and I'm being left behind."