Full-service hospitals are an endangered species in sparsely populated areas. At least 116 rural hospitals have closed since 2010, mostly in the Southeast. The reason is simple math. Many isolated towns are losing jobs and people -- especially young ones. That leaves a population that relies mainly on Medicare and Medicaid. With no urgent care clinics in these communities, patients often visit emergency rooms when they have the flu or a minor injury. Federal Medicare payment cuts also are a factor. The net result is a severe financial strain for hospitals already hit by unpaid bills in low-income regions. Closures are likely to continue, a recent study predicts. Medical economists at iVantage Health Analytics, a consulting firm in Newton, Mass., estimate more than 600 hospitals in the United States are at risk of shutting. Thirty-four states have at least five rural hospitals at risk of closing, according to a separate report by Chicago management consultants at a firm named Navigant.

Care for expectant mothers is especially affected as small hospitals balance the cost of 24/7 delivery services against falling birth rates, tight finances and shortages of doctors and nurses. More than 179 rural counties have lost hospital obstetric (pregnancy) care since 2004. Some women must drive hundreds of miles for checkups, shots or hospital tests. "A hospital is one of those things -- you don't notice it's not there until you need it," says Mark Holmes, a University of North Carolina professor studying the trend.

Government officials and health industry leaders are scrambling to avoid what are called "health care deserts." Tactics include video consultations with distant specialists and partnerships with larger providers to share costs and bridge gaps in expertise and innovation. In Pennsylvania, five sites participate in an innovative Rural Health Model pilot program – the first experiment aimed at ensuring the financial stability of "critical access hospitals," as described in the video below. Instead of getting paid when a patient is treated, each instead receives a monthly budget payment from state government and insurers. "This model will preserve access to health care in our communities. while at the same time saving jobs," says Dr. Rachel Levine, head of the state health department. She hopes up to 30 hospitals will benefit by 2021.

Missouri woman says: "Our community is just in panic. They don't know what to do." -- Deloris Johnson of Kennett, Mo., where the nearest hospital shut in 2018

Hospital executive says: "We were only seeing three or four people every 24 hours. However, we still had to staff it with a physician, we had to staff it with nurses, we had to staff the lab." – Tom Majure, former hospital chief executive in Scotland Neck, N.C., that shut in 2017

Consultant says: "The rural hospital crisis must be addressed and could significantly worsen with any downturn in the economy. Local, state, and federal politicians, as well as health system administrators, need to act." -- David Mosley, managing director at Navigant consulting firm in Chicago