It is hard to operate a rural hospital. Rural areas not only are dwindling in population but tend to be poorer. There's a higher mix of Medicaid/Medicare plans

It is hard to operate a rural hospital. Rural areas not only are dwindling in population but tend to be poorer. There's a higher mix of Medicaid/Medicare plans versus employer health plans. With our current fee for service medical service economic model, rural hospitals that don't do as many surgeries or have to transfer people to the city hospital literally send patients and the revenue they bring in off to big cities. Recruiting staff is harder due to in demand professionals wanting the services and opportunities a big city provides. County hospital are partially local taxpayer supported but once again rural areas have a thinner tax base. HHS sends Federal dollars but this is limited. Certain states are trying extra hard to exacerbate the problem by not expanding Medicaid.