Rural obstetric unit closures are associated with adverse maternal and infant health outcomes and are most common among low–birth volume facilities located in remote areas. Declining access to obstetric care is a concern in rural communities in the US. This study, published in JAMA Health Forum, offers results from a national survey of a sample of 292 rural hospitals that provided obstetric services in 2021. Obstetric unit administrators shared about their experiences, the challenges they face, and the decisions that factor into providing labor and birth care for their rural communities.