Since 2010, 95 rural hospitals in 26 states have closed, according to a recent Navigant report (http://www.navigant.com/insights/healthcare/2019/rural-hospital-sustainability). Contributing factors include declining population growth and need for inpatient care; poorer payer mix owing to more Medicaid, Medicare, and uninsured patients; and reduced Medicare payments, according to the report. The report also found that 21% of rural hospitals in 43 states are at "high risk" of closing if their financial situations do not improve. Of these hospitals, 64% are considered "essential to their communities." Financial issues are also a factor in rural nursing home closures, the New York Times recently reported (http://www.nytimes.com/2019/03/04/us/rural-nursing-homes-closure.html), in which nursing home residents are forced to transfer to a home farther away from their families, resulting in disrupted routines and fewer visits from spouses and children.