Across the United States, more than 120 million people live in communities classified as healthcare deserts that severely limit access to medical services.
Recess turns into a sprint across the dry field, and an asthma attack begins as Micah’s laugh snaps into a cough that will not stop. The nurse calls his mom. His rescue inhaler at home is empty after a hard month, the town pharmacy is gone, and the nearest chain store is over thirty miles away.
Talia signs him out, buckles him in, and points the car toward the nearest emergency department, which is over 30 miles away in this healthcare desert. For Micah, each breath is a struggle as Talia breaks the speed limit on the highway to reach the ER as quickly as possible.
Patients in healthcare deserts face serious barriers to care. Distance is only part of the challenge. Infrastructure is aging, providers are scarce, and systems are stretched thin.
When healthcare becomes a logistical or financial burden, the result is delayed diagnoses, unmanaged chronic conditions, and deeper health inequities. For people in a healthcare desert like Talia and Micah, it is a constant struggle to get the care they need when they need it.
Why Healthcare Deserts Continue to Grow
They pull into the emergency entrance, Talia parks, helps Micah out, and they hurry inside. The doctor explains the plan, focuses on Micah’s comfort, and checks on him at short intervals. Soon, his breathing steadies, and he’s discharged.
A healthcare desert is a geographic area where residents face significant barriers to accessing essential health services. This includes limited or no availability of hospitals, primary care providers, and pharmacies.
In many cases, individuals in healthcare deserts must travel extensive distances to receive routine or urgent care. For residents without reliable transportation, flexible work schedules, or adequate insurance coverage, this distance creates a significant barrier to accessing care.
Healthcare deserts are most commonly found in rural and underserved urban areas. However, they vary in cause and scope. Some healthcare deserts exist because the nearest facility has closed. Others result from longstanding provider shortages, outdated infrastructure, or chronic underinvestment in care delivery.
These factors contribute to delayed diagnoses, unmanaged chronic conditions, and increased reliance on emergency services.
The persistence of healthcare deserts stems from both structural and socioeconomic challenges. In many rural areas, residents may lack access to hospitals, clinics, trauma centers, or even a local pharmacy. Travel distances for routine or urgent care can span dozens of miles, often without means of public transportation.
Socioeconomic conditions amplify healthcare desert barriers. Limited insurance coverage, high poverty rates, and restricted access to digital technology create additional challenges for some areas. Common obstacles include transportation costs, availability of paid time off, and internet connectivity for telehealth visits.
Rural Hospital Challenges That Lead to Healthcare Deserts
Talia picks up two inhalers from the nearby pharmacy. One goes to the school nurse with a signed form, one stays on the kitchen shelf. This close call proves that fast access to care is not a guarantee in healthcare deserts.
Over the past two decades, rural hospitals have faced mounting financial pressures, resulting in widespread service reductions and closures.
Between 2005 and 2023, 146 rural hospitals either closed or ceased offering inpatient services. Of these, 81 hospitals shut down entirely, while the remainder transitioned into limited-scope or outpatient-only facilities.
Nearly half of all rural hospitals now operate at a financial loss, and 432 are considered at immediate risk of closure. This economic strain contributes to healthcare deserts that erode the availability of core services, including inpatient care, emergency departments, and obstetrics.
The consequences of healthcare deserts extend beyond access to care. Hospitals are often economic and social anchors, supporting higher employment rates and healthier communities.
The Role of Critical Access Hospitals in Reducing Healthcare Deserts
Critical Access Hospitals (CAHs) play an essential role in maintaining healthcare access across rural America. Established under the 1997 Balanced Budget Act, the CAH designation was designed to prevent hospital closures that lead to healthcare deserts in isolated areas by providing financial relief and regulatory flexibility.
Today, more than 1,350 hospitals operate as CAHs, serving millions of Americans who would otherwise face long delays or travel distances for basic medical care. To qualify for CAH status, a hospital must:
- Be located at least 35 miles away from another hospital (or a 15-mile drive in an area with mountainous terrain or only secondary roads.)
- Provide 24/7 emergency care
- Have no more than 25 inpatient beds
- Maintain a 96-hour maximum average for acute care
These facilities often serve as stabilization points, delivering emergency care, outpatient services, and short-term inpatient stays before transferring patients to larger hospitals when necessary.
This model has proven effective in preventing many communities from falling into full healthcare desert status. A study of Medicare patients found that 30-day mortality for life-threatening conditions was similar at rural CAHs and urban hospitals.
However, despite receiving cost-based reimbursement from Medicare, CAHs remain financially vulnerable. Between 2005 and 2024, more than 70 CAHs closed, and these closures disproportionately affect regions already facing workforce shortages, infrastructure limitations, and lower health insurance coverage rates.
Challenges to Growth: Opening New Facilities in a Healthcare Desert
Establishing new healthcare facilities in underserved regions is a complex endeavor. It involves a combination of economic, logistical, and workforce-related constraints.
Capital investment and sustainability
Building a new hospital requires substantial financial investment, with the average cost ranging from $60 million to $190 million. In many rural areas, the population may be too small or low-income to support long-term operational costs. Health systems and investors often require assurances of financial viability before committing to expansion.
Provider recruitment and retention
Rural regions frequently struggle to recruit and retain clinical staff. Physicians, nurses, and specialists may prefer urban or suburban settings with greater professional networks, higher salaries, and more opportunities for advancement. Even when facilities are built, insufficient staffing can prevent them from operating at full capacity.
Regulatory and reimbursement challenges
Underserved providers often encounter complex billing and compliance requirements, particularly when serving Medicaid or uninsured populations. Lower reimbursement rates and high uncompensated care burdens reduce the incentive to expand into these areas.
Infrastructure limitations
Some rural areas lack the infrastructure needed to support new healthcare facilities. This includes reliable roads, utilities, broadband internet, and emergency transport networks. In some cases, rural healthcare construction costs can reach unsustainable levels.
Burnout and staffing fatigue
Even when positions are filled, rural staff often carry broader responsibilities due to limited personnel. The result is higher burnout and reduced retention, making it harder to scale operations or launch new initiatives.
A Policy Response: Rural Health Transformation Funding
Federal lawmakers have introduced new strategies to transform rural care delivery and reduce healthcare deserts through increased investment and operational flexibility. Legislative proposals designed to support rural healthcare include:
- The One Big Beautiful Bill Act (OBBB)
- The Protect Medicaid and Rural Hospitals Act
- The Calendar Year 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Proposed Rule (CMS-1834-P)
These initiatives aim to help hospitals modernize operations, expand outpatient and emergency services, and support transitions to the Rural Emergency Hospital designation.
How the OBBB Act Aims to Ease Rural Healthcare Desert Challenges
A central pillar of the current federal strategy to improve rural healthcare access is the One Big Beautiful Bill Act. This legislation proposes a $50 billion investment over 5 years to create the Rural Health Transformation Fund, a major federal commitment aimed at stabilizing rural health systems.
The fund is structured to address both short- and long-term barriers to care delivery. It provides financial support to rural hospitals transitioning to the Rural Emergency Hospital (REH) model, which is designed for small, low-volume facilities that can no longer sustain inpatient services.
Funding may also be used to upgrade outpatient departments, invest in broadband and digital infrastructure, and stabilize key service lines such as emergency care, behavioral health, and maternal services.
The Protect Medicaid and Rural Hospitals Act Doubles OBBB Investments
The Protect Medicaid and Rural Hospitals Act builds on the OBBB by proposing to increase federal investment to $100 billion over ten years. The bill maintains the same priorities of modernization, access, and stability, but extends the funding timeline to support longer-term planning and execution.
By extending both the scale and duration of funding, this legislation aims to give rural providers the capacity to implement structural reforms and adopt sustainable models of care. Together, these legislative proposals signal a broader federal commitment to rural health equity and infrastructure.
The Rural Emergency Hospital Quality Reporting Program
The Rural Emergency Hospital Quality Reporting (REHQR) Program is a key part of the Centers for Medicare and Medicaid Services‘ effort to ensure accountability and continuous improvement among REHs. Under this program, participating hospitals are required to report data tied to a defined set of quality measures.
CMS has proposed several updates to streamline requirements while preserving oversight. One such update is an optional electronic clinical quality measure focused on emergency care access and timeliness. This measure would replace certain time-based metrics and better reflect the operational conditions of rural providers.
CMS has also proposed removing some existing measures, including those related to emergency department utilization and social determinants of health. While these changes reduce administrative workload, they may also reduce visibility into local health equity issues.
A final proposed update would allow reporting extensions under the Extraordinary Circumstances Exception policy. This provides added flexibility during periods of disruption, including staffing shortages and natural disasters.
Operational Challenges of Rural Practices in Healthcare Deserts
Improving rural healthcare access requires more than new buildings or funding. It also depends on whether providers can operate effectively in environments with limited capacity.
Rural organizations are often expected to deliver a full range of services with small teams, aging infrastructure, and narrow financial margins. Administrative requirements continue to increase, while support resources often do not.
The result is a set of operational challenges that undermine the impact of well-intentioned investments and contribute to healthcare deserts. Common operational challenges include:
- Workforce shortages that affect clinical and support operations
- Administrative burden that slows down care coordination and reimbursement
- Technology limitations that restrict information flow and access
Until these areas are strengthened, healthcare deserts will remain difficult to address.
Short Staffing and the Strain on Rural Practices in Healthcare Deserts
Workforce shortages continue to constrain rural healthcare systems, even when new funding becomes available. Rural areas are served by a small share of the national healthcare workforce. Up to 25% of rural physicians are nearing retirement, and younger providers are less likely to relocate without incentives or career development opportunities.
Shortages are not limited to physicians. Nursing, administrative, and allied health roles also experience high turnover and limited pipeline development. These challenges are often driven by inadequate support, professional isolation, and a lack of local housing or childcare options.
Staffing gaps lead to reduced service availability, longer wait times, and diminished care coordination. Back-office functions such as billing and documentation may also fall behind, affecting financial performance and regulatory compliance.
Addressing healthcare desert challenges requires a comprehensive approach that includes recruitment, retention, and system-wide support strategies.
Back-Office Bottlenecks That Undermine Rural Healthcare Efficiency
Administrative teams in rural healthcare systems play a critical role in daily operations. Their responsibilities include medical records, billing, reporting, scheduling, and prior authorization.
When administrative capacity is limited, delays and errors increase. Record requests, audit responses, and reimbursement claims may be missed. Coordination between care settings slows, and patient outcomes suffer.
Prior authorization is a growing concern. These requirements can be time-intensive and complicated, particularly for teams already working beyond capacity. In 2024, CMS finalized rules to simplify prior authorization for Medicare Advantage, Medicaid, and CHIP. These changes, set to take effect in 2026, are expected to reduce burden and improve response times. However, broader adoption and consistent implementation remain ongoing challenges.
Enhancing administrative functions is essential for improving access to rural patients in healthcare deserts and reducing burnout.
Bridging the Digital Divide to Ease the Challenges of Rural Healthcare Deserts
Modern healthcare depends on digital tools, but rural systems often lack the resources to adopt and maintain them. Gaps that lead to healthcare deserts include poor broadband connectivity, aging equipment, and insufficient IT support.
The U.S. Department of Agriculture reports that 22.3 percent of rural Americans, and 27.7 percent of residents on Tribal lands, lack coverage of fixed terrestrial broadband at the FCC benchmark speeds of 25 Mbps download and 3 Mbps upload, compared with just 1.5 percent in urban areas.
Electronic health record (EHR) adoption is another challenge. A 2024 study found that 64% of rural primary care physicians use certified EHRs, compared to 74% in urban areas. Rural providers also report lower interoperability capabilities, which complicates care coordination in healthcare deserts.
These gaps make it harder to coordinate care, share data, and meet reporting requirements. Investing in scalable, secure, and affordable technology is critical for rural systems seeking to modernize and ease healthcare desert challenges.
Making the Most of Every Dollar: How ChartRequest Supports Rural Health
In healthcare, every minute and every dollar counts. When provider time is limited, operational efficiency becomes the key to expanding healthcare access to rural communities.
We can’t build a new hospital in your town. We can’t hire your next nurse. But we can take one thing off your plate: the administrative burden that steals time from patient care.
ChartRequest helps rural hospitals, clinics, and community health centers cut hours of back-office work each week by automating medical records requests, simplifying HIPAA compliance, and accelerating turnaround times.
When every minute matters, let us handle the paperwork, so your team can focus on delivering impactful care to patients like Micah.
Schedule a personalized consultation to learn how ChartRequest helps rural healthcare practices streamline operations and care for more patients in their communities.
