For a small plains town, the local hospital is far more than a place of medicine. It is often the largest employer for miles, the reason a doctor and a pharmacist will live in the community, and the difference between a heart attack survived and a heart attack fatal when the nearest city is a hundred miles off. Keeping its doors open is among the hardest economic struggles the countryside faces.

A Lifeline Worth Fighting For

The arithmetic is unforgiving. A small hospital serves too few patients to easily cover its costs, struggles to recruit staff to a remote town, and depends heavily on the terms of distant insurers and public programs. Many have closed; others survive only by affiliating with a larger regional system or by the fierce support of the communities they serve.

From the almanac's reckoning:

• The local hospital is often a small town's largest employer.
• Too few patients and hard recruiting threaten rural hospitals' survival.
• Many survive only by affiliating with a larger regional system.

Where a town rallies to save its hospital, it saves much more than a building. The almanac counts the rural hospital among the most precious and precarious institutions of the plains — a lifeline the countryside cannot afford to lose.