Since 2005, 170 rural hospitals closed. The North Carolina Rural Health Research Program and Policy Analysis Center tracks these closures and studies potential predictors. Profitability is not the only predictor, but it is one of the main predictors of hospital closure. Researchers and policymakers are trying to better understand what leads up to a closure and how to develop sustainable healthcare models for communities that lose their hospital services. These studies underscore some of the more recent challenges facing rural hospitals. Add these to the age-old challenges of lower volume, poorer and sicker patient populations, and it's not hard to understand why some hospitals may be in trouble. To help policymakers, researchers, and communities understand which hospitals are likely to be less profitable, this study describes the geographic variability in 2018 profitability of Critical Access Hospitals, other rural hospitals, and urban Prospective Payment System hospitals by census region, census division, and state.