Rural tech renaissance: How small hospitals are using innovation to stay alive

In rural eastern Colorado, a critical access hospital serves communities across 600 miles, operating on razor-thin margins. For residents here, the hospital isn’t just a healthcare facility—it’s often the difference between life and death when injuries occur on remote farms or when chronic conditions flare up miles from specialized care.

A compound fracture on the farm could mean a life-or-death situation depending on access to care, noted Chris Spearman of ScaleHealth during the “Friends in Rural Places” session at ViVE 2025. “I have had family members lose their lives because they couldn’t get access quick enough because of where they live. That should not be the US we live in and it does not have to be our reality.”

In Montana, a hospital CEO shared his facility is the largest employer in a town of 300 people without a single paved street, where patients sometimes arrive by tractor rather than ambulance. Meanwhile, in Bandon, Oregon, a coastal hospital remains the only care facility for hours in any direction, serving a community of retirees who would otherwise face grueling journeys for routine care.

These scenarios illustrate the precarious reality facing America’s rural healthcare system.

“The rural safety net is not only being eroded, it’s being ripped apart,” Spearman continued. “A Becker’s report came out last week that 432 hospital systems across the US in rural settings are at risk of closure.”

The Triple Threat: Workforce, Resources, and Access

Across four different panel discussions at ViVE 2025, rural healthcare leaders consistently identified three interrelated challenges: workforce shortages, resource limitations, and patient access barriers.

“Workforce, workforce, workforce,” emphasized Ryan Thousand, CIO at Dahl Memorial Healthcare in Montana. “It doesn’t matter what I do in technology…we don’t have the people that have the skill sets in depth to facilitate the needs of the rural area.”

This workforce crisis compounds the financial pressures that already threaten rural hospitals. Nearly half of United States rural hospitals are losing money on operations, according to Brock Slabach, COO at the National Rural Health Association, speaking at the “Price Transparency and Data: An Oasis for Rural Healthcare Organizations” session.

“We have 20% of the country’s population, and we have over 80% of the land mass,” Salabaugh explained. He called this “the tyranny of low volumes” – the fundamental challenge that makes delivering rural healthcare difficult.

Rachelle Schultz, President and CEO of Winona Health in Minnesota, pointed to difficulties recruiting pharmacy technicians and other specialized staff that larger urban centers can more easily attract and retain. For many facilities, the retirement of experienced workers has created knowledge gaps that aren’t easily filled, especially in specialized areas like medical billing.

Technology as a Force Multiplier

Despite these challenges, rural healthcare leaders are finding innovative technological solutions to address their unique needs.

At Sanford Health, the nation’s largest rural healthcare system spanning from Wyoming to Michigan, telehealth has become transformative. Dave Newman, the organization’s Chief Medical Officer, described how their telestroke program has improved life in western North Dakota.

“We found that people were dying at a higher rate in the western part of the states from strokes because they couldn’t get access to a neurologist,” Newman explained. “We rolled out the telestroke program using our existing technology and we were able to save lives doing that.”

Newman described how Sanford repurposed telemedicine carts to provide pediatric infectious disease consultations in critical access hospitals, allowing patients to stay closer to home while receiving specialized care. He also shared how one neurosurgeon, unable to travel during a snowstorm, conducted all appointments virtually, ensuring continuity of care despite severe weather conditions.

This is particularly important in regions like North Dakota, where winter conditions can make travel impossible. “It’s negative 40 in Fargo right now,” Newman noted during his presentation. “When we have a snowstorm, there is no access to specialty care.”

Addressing Administrative Burdens Through AI

Technology also helps tackle administrative burdens. Through Microsoft’s Rural Health Resiliency Program, rural hospitals are gaining access to AI tools specifically designed for their needs.

“Claims Co-Pilot was developed to address challenges and help billers of all levels streamline their workflow,” Laura Kreofsky, who leads Microsoft’s program, explained during a demonstration. The tool, estimated to cost just $4 per day to operate, helps rural hospitals process Medicare and Medicaid claims more efficiently.

The Claims Co-Pilot tool addresses a specific pain point in rural healthcare: handling denied insurance claims. By some estimates, the healthcare industry spends about $20 billion annually dealing with claim denials. For critical access hospitals, this translates to approximately $330,000 per facility – a significant sum for institutions operating on thin margins.

The Patient Experience

Faith Polkay, CEO of Buford Jasper Hampton Comprehensive Health Services in South Carolina, noted that contrary to assumptions, rural patients have generally embraced telehealth. “The interesting thing is you would think that for patients there was a trust factor. There really isn’t. Patients are excited about it when we’re excited about it.”

Her health center implemented remote patient monitoring for hypertension management, ensuring devices were cellular-enabled rather than requiring smartphone connectivity: “It has increased our hypertension control almost 20 percentage points in three years.”

However, healthcare leaders emphasized the need to balance technological solutions with the personal connection that defines rural healthcare. As Schultz from Winona Health noted, “Health care is a people business. We are people-first and high touch-first. I think we have to be careful that we’re not interrupting the valuable relationships that people have with their doctors, their nurses, their therapists.”

The Road Ahead

As rural hospitals navigate these challenges, conference speakers emphasized the importance of starting small and building momentum.

“Get started, do something,” urged Schultz. “The status quo isn’t working, it’s falling apart, it’s unraveling around us.”

Many rural healthcare leaders expressed optimism about AI’s potential but acknowledged the need for practical solutions that fit their resource constraints. Ryan Thousand compared rural hospitals to speedboats rather than cruise ships: nimbler and potentially more adaptive to change, especially when they work together.

“We’re not cruise ships, we’re that little bitty speed boat out there,” Thousand said. “If we get all the speedboats together, all of a sudden we’ve got a cruise ship.”

Thousand also emphasized that technology investments in rural communities extend beyond healthcare: “In rural areas, technology is a force multiplier when it comes to your economy. I’m the largest employer in town. That’s not a good thing. For the health system to be the largest employer in town is actually kind of scary.”

By training local talent in technology skills, rural hospitals can potentially catalyze broader economic development. “If I’m able to place somebody that knows how to work on point of sale systems, and we train them on the right tools… this person that’s now skilled decides he’s going to create his own company and he hires 10 more people. Now all of a sudden, I’ve got an extra million dollars in revenue in my community.”

The message from ViVE 2025 was clear: rural healthcare solutions will come from rural communities themselves, with technology serving as an enabler rather than a panacea. As Schultz observed, “A lot of the solutions for rural healthcare are going to come out of rural healthcare. When I talk to payers, they’re willing to do things. They’re willing to be creative, but they don’t have the ideas. The ideas have to come out of our organizations.”

As rural communities continue fighting to maintain healthcare access, these technological innovations and collaborative approaches may provide the lifeline needed to keep country hospitals—and the communities they serve—alive.