Many rural Americans are squeezed between greater health care needs and fewer resources. Although adults living in rural areas are more likely to live in poverty and have greater unmet health needs than those in urban areas, there is a severe shortage of primary care, behavioral health and other specialty care providers.

Despite their central role in providing rural health services, more than 100 rural hospitals have closed over the past 15 years, and many of those that remain open have merged with other hospitals or health systems. After a merger, hospitals may reduce service lines that are less profitable or that duplicate services offered by merger partners. Reductions in services provided by these hospitals may be associated with negative health outcomes if patients must travel farther to receive care or if clinicians who offered those services move from the area.