Documents the variance in profitability among small-town rural hospitals and evaluates the characteristics that distinguish highly profitable small-town hospitals from struggling ones. It also reports on strategies that small-town hospital administrators are using to achieve financial success and discusses public policy priorities for assisting small-town hospitals in rural America.

Among the findings are that patient volumes appear to explain a significant portion of the difference in small-town hospital profitability. No small-town hospital with fewer than 300 admissions was able to generate significant profits and no small-town hospital with more than 2,500 admissions generated significant losses. Among the hospitals with between 300 and 2,500 admissions, there is a wide variance in profitability. The case studies suggest that lower staffing levels and higher levels of visiting specialists can improve profitability. They also suggest that bad debt burdens can create significant financial strain.