Hospital Deserts Across America

Hospital deserts are not random. They concentrate in areas where decades of population decline, economic contraction, and policy gaps have eroded the financial viability of community hospitals. Rural counties that lose population lose patients, and hospitals that cannot fill beds cannot cover fixed costs. When a hospital closes, the county often becomes a permanent desert — no new facility replaces it.

Since 2005, 195 rural hospitals have closed, converting functioning healthcare infrastructure into desert counties. Closures accelerate a cycle: when a hospital closes, physicians and nurses relocate, nearby facilities absorb overflow patients, and emergency transport times increase. Studies show that counties losing their only hospital see measurable increases in mortality for time-sensitive conditions like heart attacks and strokes.

Financial distress is the proximate cause of most closures. Hospitals operating with negative margins and low occupancy rates face impossible choices between reducing services and accumulating debt. Critical Access Hospitals — facilities with 25 or fewer beds that receive cost-based Medicare reimbursement — are partially insulated, but not immune. Many rural hospitals that are not CAH-designated operate on margins thin enough that a single bad year can trigger closure.

Workforce shortages compound the problem. The HRSA Health Professional Shortage Area program currently tracks 35,534 active shortage designations nationally. Rural communities struggle to recruit and retain physicians, nurses, and specialists — and hospitals in desert-adjacent counties bear the burden of serving populations beyond their own borders. Addressing hospital deserts requires coordinated investment in infrastructure, workforce, and data systems that can identify at-risk facilities before they reach the point of closure.