Sayre Memorial Hospital is one of 79 rural hospitals to have closed in the United States since 2010. As in similar communities, the financial margins for the town’s hospital, nursing homes and doctor are slim.

“We know that rural hospitals disproportionally serve our low-income, older, sicker populations in the country, and to the extent that we can assure that they have the insurance there to pay for that care will be vital for rural hospital viability,” said Mark Holmes, a professor at the University of North Carolina and director of the North Carolina Rural Health Research and Policy Analysis Center.