A drug discount program has become a financial lifeline for rural hospitals like Pemiscot County, nearly a third of which are struggling to keep their doors open. Now, a pending rule change may scale it back dramatically. It’s yet another hurdle for rural communities fighting to keep their healthcare local.

No one at the hospital in Fulton, Missouri (population 12,790) had ever heard of a management consultant named Jorge Perez until he showed up at its potluck in September.

It’s not uncommon for pregnant women in rural America to have to travel to give birth; the percent of rural counties without hospital obstetrics has increased in recent years to 54 percent, up from 45 percent in 2004.

For the nearly 700 rural hospitals in the United States on the brink of financial collapse, relatively small amounts of money can be the difference between life and death. There are many variables that can strengthen their chances of survival.