In 2024, two Medicare ACO initiatives will have increased participation by rural providers: the Shared Savings Program (SSP), the permanent ACO program, and the ACO REACH Model, which intends to improve access to and care for underserved populations, including those in rural areas. Accountable care organizations (ACOs) are groups of doctors, hospitals, and other health care professionals that work together to give patients high-quality, coordinated service and health care, improve health outcomes, and manage costs. This year, both SSP and ACO REACH will have over 25 percent more participation from Federally Qualified Health Centers, Rural Health Clinics, and Critical Access Hospitals than in 2023. The increase in SSP is due, in part, to recent changes in the program intended to encourage participation among providers from rural and underserved areas. Even though the transition from volume-based payment (i.e., fee-for-service with no connection to value) to value-based payment has been slower in rural America than in urban areas, increased rural provider participation in these initiatives furthers the CMS goal for all beneficiaries with traditional Medicare to be in a care relationship with accountability for quality and total cost of care by 2030.