Indiana lawmakers have seized on high health care costs as a priority problem to tackle this legislative session, but rural hospitals with thin profit margins are worried — and want more help from the state.

In many rural towns, local hospitals are community fixtures. When they close, the entire community feels the ripple effects.

Transferring a critically ill patients is becoming increasingly difficult, according to hospital leaders, government officials and industry advocates. Patients are spending hours — or sometimes days — in rural hospital emergency rooms waiting for an ambulance.

Cities are getting hit the hardest by the coronavirus right now. In Indiana, nearly half of the confirmed cases are in Marion County, but with the expected surge still weeks away, rural communities face additional challenges.

In Missouri, six rural hospitals closed in the last five years. It's part of a group of states that have seen higher rates of closures -- states that haven't expanded Medicaid.

This five-part series examines the financial problems faced by rural hospitals across the U.S. More than 110 have closed in less than a decade, and the trend accelerated last year. Others have cut services such as maternity wards to survive.

To survive, Wisconsin's rural hospitals are consolidating, getting creative about doctor recruitment and tapping new segments of the medical market.

To help address a shortage of medical professionals, a University of Missouri program immerses future doctors, pharmacists, nurses and other health workers in small-towns.

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.