In Humphreys county, Mississippi, for instance, three-quarters of residents are black and nearly 40% live in poverty. The hospital there closed in 2012. In Barnwell county, South Carolina, which lost about 6% of its population from 2010 to 2017, residents learned on Facebook in January 2016 that their hospital would shutter the following day.

Many people in these areas piece together incomes with contract jobs that don’t offer insurance. Hospitals are often left to pay the bills for the poorest and sickest, and the math worsened as legislatures in the region rejected Medicaid expansion under the Affordable Care Act. The non-partisan Kaiser Family Foundation acknowledged in March that Medicaid is having a “disproportionately positive impact in rural areas in expansion states”. The forces combine to create an unequal healthcare landscape, with urban hospitals producing an average 6% profit each year, while rural hospitals are at 2%.

In June, the hospital in Jacksonville, Alabama, will be the first rural hospital to close in 2018. While the deceleration of closures should be an encouraging development, rural health champions wonder if it will make lawmakers less likely to help the areas left behind.