While most headlines focus on the affordable housing crisis, middle-income housing stock is suffering for low supply levels as well. The ULI Terwilliger Center's 2021 Home Attainability Index shows a lack of attainably priced housing in the 50 most populated markets in the US. Essential workers have been the most impacted by the shortage.

The shortage of middle-income housing is evident in markets across the nation, but the most populated markets pose the most severe shortages. There was a clear distinction in housing attainability between small and large metros. The top 20 markets with the most severe affordability issues were generally larger markets with a population exceeding 4.2 million people. However, smaller regions with a population between 1.27 million and 2.6 million generally had improved affordability.

It is worth noting that many large markets generally exceed the median of affordable and attainable housing supply, and for that reason weren't listed as the "worst" markets for affordability. The list includes San Jose, Honolulu, Oxnard, San Francisco, Bridgeport, New York City, Boston, New Haven, Baltimore and Hartford.