The issues that seem difficult for health care providers everywhere in the US–access, coverage, staffing, cost and quality–are often magnified in rural settings.  And rural providers may not be able to provide the whole suite of services that are available in large urban centers.  Primary care and women’s health needs are two of the areas that are most difficult for many rural communities to adequately staff.  What’s happening in rural health care is often described as a crisis as consolidation, mergers and acquisitions can lead to communities being absent a hospital at all.  Given how hospitals are generally there largest employers in small towns and pillars of communities the loss can be profound.  George Pink, PhD. is the Deputy Director of the North Carolina Rural Research Program, Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.  He joins us to have a wide-ranging discussion of the challenges facing those providing and seeking health care in sparsely populated locations around the country.