Between 2011 and 2017, both median overall profit margins and the proportions of profitable rural hospitals declined. This is a stark contrast to the improving financial conditions of urban hospitals during this same time. To make things worse, the COVID-19 pandemic has amplified existing financial pressures twofold on rural hospitals. The CARES act and other pieces of legislation have alleviated some of this pressure in the short run, but long run solutions will need to be implemented when the pandemic ends. Expanding eligibility for Medicaid and making explicit payments to cover the costs of standby services in rural hospitals are a few ways rural healthcare can begin to operate at a financial gain.