More Americans are now aware of the financial challenges faced by rural hospitals. Media coverage of the 66 rural hospital closures between January 2010 and January 2016 has highlighted the healthcare access and economic challenges facing rural America. Rural hospital closures are not a new phenomenon – hundreds of rural hospitals closed in the 1980s and 1990s. Recognizing that many rural hospitals are the only healthcare facility in their community and that their survival is vital to ensure access to healthcare, federal policymakers created four classifications of rural hospitals that qualify for special payment provisions under Medicare: Critical Access Hospitals (CAHs), Medicare Dependent Hospitals (MDHs), Sole Community Hospitals (SCHs), and Rural Referral Centers (RRCs). In this brief, the NC Rural Health Research Center compares the profitability of urban hospitals to that of rural hospitals for fiscal years 2012-2014 based on size and rural Medicare payment classifications.