How America is failing its rural hospitals

Why so many rural hospitals keep closing.

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Over the past 20 years, nearly 200 rural hospitals have closed, and experts warn that another 700 are at risk of closure in the near future. To put that in context, Texas alone has seen 25 hospital closures since 2005. If nothing is done, the state could lose over half the remaining small town hospitals. That means people are driving further for care, sometimes over an hour, or waiting longer to get help. These delays could lead to worse health outcomes.

Nationwide, an estimated 20% of the US population lives in rural areas. Other estimates found that 80% of counties across the US lack adequate access to health care. Unlike their urban counterparts, small town hospitals are often the entire health care system for the community, meaning they provide a wide range of services from lab tests and screening to basic primary care. When one shuts down, it means the surrounding community could lose access to all health care. There is bipartisan support to assist rural communities, and Congress has passed a number of bills over the decades to try to keep these facilities open, but it still isn’t enough. So why are so many rural hospitals shutting down?

It’s a multifaceted issue that comes back again and again to income. At its core, a hospital is a business and, often, not a very lucrative one. One recent report found that over 50% of rural hospitals are operating at a deficit. The slightest change in income could be the difference between staying open and having to shut their doors for good. Watch the piece above to learn more.

This piece is a small bite of a huge topic. Check out other pieces from Vox.com’s Dylan Scott to learn more about the challenges rural hospitals face:
Community hospitals are facing an impossible dilemma: https://www.vox.com/policy-and-politics/2022/11/28/23424682/us-health-care-rural-hospital-closures-mergers

America’s increasingly atrocious access to maternity care, explained in 3 charts:
https://www.vox.com/policy-and-politics/2022/10/13/23400901/maternity-care-deserts-march-of-dimes-2022-report

The American doctor deserts:
https://www.vox.com/policy/23753724/physician-doctor-shortage-primary-care-medicare-medicaid-rural-health-care-access

Free medical school won’t solve the doctor shortage:
https://www.vox.com/future-perfect/361620/bloomberg-johns-hopkins-free-medical-school-doctor-shortage

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Sources and further reading:

https://www.chartis.com/sites/default/files/documents/chartis_rural_study_pressure_pushes_rural_safety_net_crisis_into_uncharted_territory_feb_15_2024_fnl.pdf
https://ruralhospitals.chqpr.org/Overview.html
https://www.aha.org/system/files/media/file/2025/04/The-Cost-of-Caring-April-2025.pdf
https://www.beckershospitalreview.com/finance/hospitals-financial-burden-in-10-numbers/
https://www.ruralhealthinfo.org/topics/rural-emergency-hospitals
https://www.cms.gov/files/document/mln2259384-rural-emergency-hospitals.pdf
https://www.ruralhealthinfo.org/topics/critical-access-hospitals
https://assets.ctfassets.net/4f3rgqwzdznj/1XSl43l40KXMQiJUtl0iIq/ad0070ad4534f9b5776bc2c41091c321/GoodRx_Healthcare_Deserts_White_Paper.pdf

Other coverage I loved:
https://www.nytimes.com/2022/12/09/health/rural-hospital-closures.html
https://www.nbcnews.com/health/rejecting-claims-medicare-advantage-rural-hospitals-rcna121012
https://www.theatlantic.com/ideas/archive/2025/04/doge-rural-health-trump-alabama/682513/ Receive SMS online on sms24.me

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