The Big Fork, Minnesota municipal hospital is a chronic money-loser. But without it, local leaders fear the community's health would suffer and employers would melt away.

To avoid closing, some hospitals have cut services, including labor and delivery units. That's had a big impact on small Iowa communities.

Rural hospitals such as Fulton Medical serve as a lifeline for health care and jobs in small towns but face dwindling revenues.

Since 2010, at least 79 rural hospitals have closed across the county, and nearly 700 more are at risk of closing.