Rural hospitals are a substantial part of the U.S. health system, but they are generally smaller and serve fewer discharges than urban hospitals. The latest figures below describe their number, distribution, bed capacity, patient coverage, maternity services, and operating margins, with each statistic tied to its stated measurement year.
Contents
- How many rural hospitals are there?
- Hospital size and bed capacity
- Where rural hospitals operate
- Rural residents and hospital access
- Discharges and insurance coverage
- Maternity care in rural hospitals
- Operating margins and financial pressure
How many rural hospitals are there?
The American Hospital Association counted 1,797 rural community hospitals in its 2024/2026 annual-survey data. The same AHA dataset counted 3,324 urban community hospitals and 5,121 community hospitals in total. It counted 6,100 hospitals when all U.S. hospitals were included, rather than only community hospitals. These figures use the AHA definitions and dataset scope; they are not interchangeable with every rural-hospital count published elsewhere.
The AHA also reported 775,297 staffed beds in community hospitals and 907,216 staffed beds in all U.S. hospitals. Community hospitals recorded 33,553,725 admissions, while all U.S. hospitals recorded 35,658,583 admissions. In the same dataset, 3,567 community hospitals were in a health system. Together, these figures show the scale of the wider hospital sector alongside the rural count, without treating the categories as identical.
KFF reported a different comparison for 2023: rural hospitals accounted for 35% of all community hospitals. KFF also found that rural hospitals operated in 48 states. In 31 states, they made up at least a third of all hospitals; in 17 states, at least half; and in seven states, at least 70%. The state-level pattern matters because a national share can conceal how central rural hospitals are in particular states.
The AHA’s rural-hospital infographic described a decline between 2017 and 2021. It reported that the total number of U.S. rural hospitals declined by 105, while the total number of U.S. community hospitals declined by 75. The infographic said rural hospitals represented 71% of that community-hospital decline. Those are historical figures for 2017–2021 and should not be read as a current annual closure rate.
Hospital size and bed capacity
Rural hospitals tend to operate with limited staffed-bed capacity. In its 2021 rural-hospital infographic, the AHA counted 871 rural hospitals with up to 25 beds, 332 with 26–50 beds, 324 with 51–100 beds, and 273 with 101 or more beds. The same infographic said 47% of rural hospitals had 25 or fewer staffed beds in 2021.
The bed-size distribution is useful because “rural hospital” does not describe one uniform facility. A hospital with up to 25 beds operates at a different scale from one with more than 100 beds, even though both are included in the rural category. The AHA’s counts also add up to the rural-hospital group represented in that infographic, but the figures remain a 2021 snapshot rather than a forecast.
The wider AHA annual-survey figures provide context, but they do not give a rural-only staffed-bed total in the supplied data. The available national numbers are 775,297 staffed beds in community hospitals and 907,216 staffed beds across all U.S. hospitals. That distinction is important: a national total should not be presented as the number of beds located in rural facilities.
Where rural hospitals operate
Rural hospitals are spread across much of the country. KFF reported that they operated in 48 states in 2023. Their share of hospitals was at least one-third in 31 states, at least one-half in 17 states, and at least 70% in seven states. These measures describe the proportion of hospitals within states, not the proportion of the U.S. population living in those states.
KFF separated rural hospitals by whether they were adjacent to a metropolitan area. In 2023, 44% of rural hospitals were in areas not adjacent to metropolitan areas. Those hospitals operated in 43 states and represented 3% of all U.S. hospital discharges. The 3% figure applies to the not-adjacent group, not to every rural hospital.
The geography also corresponds to different population totals. KFF reported that 15 million people lived in rural areas not adjacent to a metropolitan area in 2023, while 31 million lived in rural areas adjacent to a metropolitan area. Across rural areas, KFF counted 46 million residents. Because these categories describe different rural geographies, they should be kept separate when considering access or service availability.
Rural residents and hospital access
KFF reported that 88% of rural residents lived in a county with a hospital in 2023. This is a county-level access measure: it indicates that the resident’s county had a hospital, but it does not specify travel time, the hospital’s services, bed availability, or whether a particular treatment was offered.
The distribution of rural hospitals helps explain why that distinction matters. Forty-four percent were in rural areas not adjacent to metropolitan areas, and those hospitals accounted for 3% of all U.S. hospital discharges in 2023. KFF also reported that 15 million people lived in these not-adjacent rural areas. The figures describe a smaller and more geographically remote segment of the rural population, rather than a measure of clinical quality or individual patient outcomes.
Rural hospitals accounted for 8% of all U.S. discharges in 2023, according to KFF. That discharge share is smaller than the 35% share of community hospitals reported by KFF for the same year. The comparison indicates that rural hospitals generally handled a lower proportion of total discharges than their proportion of community hospitals, but it does not by itself explain why or measure patient needs.
Discharges and insurance coverage
KFF’s 2023 discharge figures show a different payer mix in rural and urban hospitals. Medicare covered 53% of rural hospital discharges, compared with 45% of urban hospital discharges. Medicaid covered 19% of rural discharges and 21% of urban discharges. Private insurance covered 19% of rural discharges and 24% of urban discharges.
| Discharge coverage | Rural hospitals | Urban hospitals |
|---|---|---|
| Medicare | 53% | 45% |
| Medicaid | 19% | 21% |
| Private insurance | 19% | 24% |
These percentages are KFF’s reported coverage shares for hospital discharges in 2023. They describe payer categories, not the percentage of rural residents with insurance, and they should not be added to other measures from a different population or year. The rural-versus-urban comparison shows a higher Medicare share and lower Medicaid and private-insurance shares for rural discharges in the reported data.
KFF also reported that Medicaid financed 1.5 million births in 2023, equal to 41% of all U.S. births. Medicaid financed 47% of births in rural areas. The birth figures concern financing of births, while the discharge figures concern hospital discharges; they are related to health-care coverage but are not the same measurement.
Maternity care in rural hospitals
Hospital-based maternity care was present for most rural births in the KFF figures. In 2023, 96% of births in rural areas occurred in a hospital. That statistic describes the location of births and does not state how many rural hospitals offered obstetric services.
KFF reported that 238 rural hospitals closed obstetrics units between 2010 and 2022. Over the same period, 26 rural hospitals opened obstetrics units. These are counts of hospitals changing obstetrics-unit availability across a twelve-year period, not a single-year closure or opening rate. The difference between the reported closures and openings also should not be treated as a net change in the total number of rural obstetrics units without additional information about units that existed at the start and end of the period.
The coverage context is significant in the supplied figures: Medicaid financed 47% of rural births in 2023, compared with 41% of all U.S. births. The rural birth setting and financing measures describe different aspects of maternity care. One identifies where births occurred; the other identifies the financing source.
Operating margins and financial pressure
KFF reported that 44% of rural hospitals had negative operating margins in 2023, while 56% had positive operating margins. Within the same rural-hospital group, 15% had margins below -10% and 19% had margins above 10%. “Negative” and “positive” are broad categories; the additional thresholds show that the distribution included hospitals with more severe losses and hospitals with stronger margins.
| Rural-hospital operating margin in 2023 | Share of rural hospitals |
|---|---|
| Negative margin | 44% |
| Positive margin | 56% |
| Below -10% | 15% |
| Above 10% | 19% |
KFF also compared rural hospitals in states that had and had not expanded Medicaid. In 2023, 50% of rural hospitals in non-expansion states had negative margins, compared with 41% in expansion states. The supplied figures report an association by state Medicaid-expansion status; they do not establish that expansion status alone caused the difference.
Geography within rural America was associated with another margin difference in KFF’s 2023 figures. Forty-nine percent of rural hospitals in the most rural areas had negative margins, compared with 40% of rural hospitals in rural areas adjacent to metropolitan areas. This comparison uses KFF’s rural-geography categories and should not be merged with the separate 44% overall rural negative-margin figure as though all categories were mutually interchangeable.
The financial figures place the operating environment alongside the service and coverage measures. Rural hospitals represented 8% of all U.S. discharges in 2023, 44% of rural hospitals were in areas not adjacent to metropolitan areas, and 47% of rural hospitals had 25 or fewer staffed beds in the AHA’s 2021 snapshot. Each number measures a different dimension—volume, geography, or size—so none should be used alone as a measure of financial health or patient access.