As hospitals across the U.S. continue to grapple with financial challenges, cuts and even closures, the toll on rural communities has also increased. In 2025 alone, Becker’s has reported on 21 hospital closures. The effects of these closures can move beyond healthcare, hurting local economies and eroding the sense of community stability.

Becker’s connected with Marquita Lyons-Smith, DNP, APRN, CPNP-PC, Director of the RN-BSN Program at North Carolina Central University in Durham, to discuss the factors driving these closures, consequences for patients and providers and most promising solutions for preserving care access for vulnerable communities.

Editor’s note: Responses have been lightly edited for clarity and length.

Question: Becker’s has reported on 22 hospital closures so far this year. What do you feel are some of the factors leading to heightened facility closures?

Dr. Marquita Lyons-Smith: It seems several overlapping factors are driving this troubling trend.

First, financial fragility is a major issue; many rural hospitals reportedly operate on extremely thin margins or at a loss, largely because they must maintain 24/7 emergency capacity while serving small populations. Although inpatient census may drop, fixed costs remain, and the margins collapse even further.

Second, reimbursement challenges continue to erode sustainability. Delayed Medicaid & Medicare payments, and low private-insurer reimbursement rates all cripple rural budgets. Hospitals in states that did not expand Medicaid remain especially vulnerable because of high uncompensated care rendered to community members.

Third, several healthcare colleagues endorse the reports of workforce shortages, especially in nursing and obstetrics. Therefore, hospitals have been forced to reduce or eliminate entire service lines, such as labor and delivery, before closing altogether.

Lastly, it does not seem feasible that small facilities have the negotiating power to compete with healthcare giants.

Q: When a rural hospital closes, what are the biggest consequences for the community’s access to care?

MLS: The effects are immediate and profound. The most visible impact is increased travel time. When a rural hospital closes, patients may have to travel 20 to 40 more miles for emergency or maternity care. For stroke, trauma or childbirth, that delay can be life-threatening.

The second consequence is continuity in care. When hesitant healthcare consumers lose convenient access to obstetrics, behavioral health, and other essential care, it can be deprioritized quickly. Acute issues become chronic, and preventive care becomes illness management. We are already seeing “maternity care deserts” expand over a significant percentage of the U.S., leading to reduced mammograms and reduced opportunity to detect breast cancer early or at all.

Economically, the hospital is often a community’s largest employer. Closure can mean hundreds of job losses affecting local businesses. Research also shows per-capita income tends to decline, and unemployment rises after a hospital closure. Finally, there’s a psychological and cultural toll. A rural hospital is more than a health facility, offering a sense of community and security. Losing it can feel like losing the town’s identity.

Q: What solutions, such as telehealth, mobile clinics, or workforce training, show the most promise in addressing these gaps?

MLS: We are seeing encouraging results from several vendor-agnostic, scalable solutions:

Telehealth and virtual specialty support are critical for connecting rural providers with specialists. They allow patients to receive consults locally, reduce travel, and extend the reach of scarce clinicians. This works best when broadband infrastructure and reimbursement policies align. Also, vulnerable communities need assistance learning to use these resources effectively. Community involvement can help to fill the digital gap experienced by some elderly healthcare consumers.
Mobile clinics have proven effective for preventive care, screenings, and chronic-disease follow-up. They literally bring care to where people are, an essential strategy in geographically dispersed counties. The collaboration between NCCU and Duke University School of Nursing is an example of using mobile clinics to meet community needs in rural populations.
Workforce development and retention programs, such as rural residency tracks, “grow-your-own” pipelines, and loan-repayment incentives through HRSA, if they still exist, help build a more stable workforce. Retaining clinicians who are embedded in the community can be just as important as recruiting new ones.

Alternative facility models, such as the Rural Emergency Hospital designation, are emerging as viable options. These facilities can maintain 24-hour emergency services and observation care without the high overhead of inpatient units, supported by enhanced Medicare payments, when larger hospitals are not receiving these designations seemingly undeservingly.

Q: What policy changes or reforms would most help stabilize healthcare access in rural areas?

MLS: A multi-level policy response (federal, state and local):

Reimbursement reform: Stabilize Medicare and Medicaid rates for rural providers and explore budget models that give hospitals predictable funding tied to community health outcomes rather than volume alone. It is important to have in-house data review experts to choose a mechanism that can consistently retrieve measurable outcome information.
Provide capital assistance and technical guidance so hospitals can convert to this new model rather than close outright.
Workforce incentives: Expand loan-forgiveness, training programs, and retention grants targeted to high-need disciplines such as obstetrics, behavioral health, and emergency medicine.
Infrastructure investment: Rural health access depends on broadband, EMS, and transportation. Support these recommendations as public-health essentials, not luxuries.
Equity-focused oversight: Data show that closures disproportionately impact communities with higher proportions of Black residents and lower socioeconomic status. Federal and state programs should prioritize funding where the risk is greatest.

Ultimately, rural healthcare sustainability will depend on balancing innovation with equity and supporting local solutions that preserve access while adapting to modern realities.

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