STUART, Va. (WDBJ7) You don't have to walk far in downtown Stuart to find some strong opinions about the loss of the local hospital.
"So many old people here, worried that all of a sudden something will happen," Cecil Akers told WDBJ7.
"They would have to go to Martinsville or Mt. Airy and some of them might not make it that far," added Loraine Rucker. "So we need our hospital."
Pioneer Community Hospital of Patrick County closed in September, after a deal to sell the facility fell through.
Earlier this month, Governor Ralph Northam signed his first piece of legislation there, extending the hospital's state license, but the struggle to find a new operator continues.
Jonathan Large is a local businessman, and a former member of the Board of Supervisors.
"It's just scary to think, okay if I were to have a heart attack today, where is the nearest hospital, How soon can i get there," Large said.
There is better news in some other areas.
Centra Health recently reopened the emergency room at Bedford Memorial after a $4 million renovation.
Carilion Clinic is expanding facilities at Giles Community Hospital, with a 10,000 square foot addition that will house specialty care when it opens later this year.
And at Carilion Franklin Memorial Hospital, helping repeat emergency room visitors find a medical home has improved health outcomes and the hospital's finances.
But hospital administrator Bill Jacobsen says continued cuts to Medicaid and Medicare reimbursements, and no Medicaid expansion have taken a toll on many hospitals.
"We've worked really hard to be efficient," Jacobsen said in an interview, "but there's only so much blood you can get out of the turnip, and a lot of our hospitals are failing because of it. And it's a struggle."
It's also a struggle to recruit doctors to rural areas.
In many parts of Virginia the shortage of doctors is a continuing challenge.
Wendy Welch is the Executive Director of the Graduate Medical Education Consortium.
"We are still in deep need of primary care physicians and we have some specialties that are woefully underserved," Welch said, "but overall we are still trying to solve our own problems by training in rural areas."
Adam Tate is a fourth-year student at the Virginia Tech Carilion School of Medicine. He grew up in Carroll County, where his father is a doctor. And Tate hopes to one day have his own rural practice.
"The biggest indicator of whether a person is going to end up practicing in a rural area is if they came from a rural area," Tate said. "I like being part of a community as opposed to being separate from the community, so as a rural practitioner you do get to know your patients really well."
Tate is the exception rather than the rule. Just a small percentage of medical school graduates plan to practice in rural areas.
While the challenges remain, Tate says he's encouraged that rural health care now has the attention of the public and policy makers.