Access to healthcare depends on more than having insurance or finding a physician. In rural communities, where distances are greater and healthcare resources are often more limited, access to healthcare depends on whether essential services are even available. 

The American Hospital Association’s recent report, America’s Rural Hospitals at a Crossroads: Challenges, Consequences and Paths to Sustainability, underscores the magnitude of the challenge.¹ Low patient volumes, workforce constraints, aging infrastructure, and inadequate reimbursement have left many rural hospitals financially vulnerable. When these facilities reduce services or close, the consequences extend beyond hospital walls. Patients may face longer travel times, delayed treatment, and additional costs, while communities lose important employers and economic anchors.

Laboratory services are an essential part of this equation. Timely, accurate diagnostic testing informs clinical decisions across emergency, inpatient, outpatient, and preventive care. But maintaining that capacity requires more than instruments and infrastructure. It requires qualified professionals to operate laboratories, ensure quality, interpret results, and keep testing services running reliably. And that workforce is under pressure. A 2018 article in Critical Values, published by the American Society for Clinical Pathology, examined the unique barriers facing rural laboratory medicine and highlighted the need for targeted approaches to recruitment, education, and retention.² In June 2026, the ADLM published an article that examined the persistent national laboratory workforce shortage, citing elevated vacancy rates, rising retirement rates, burnout, and an educational pipeline that is not producing enough graduates to meet demand.³ Limited faculty, clinical training opportunities, and awareness of laboratory careers compound the problem. For rural laboratories, these national challenges can be particularly difficult to navigate when recruitment resources and access to training partnerships are limited.

There are reasons for optimism. The federal Rural Health Transformation Program is directing $50 billion to states over five years to strengthen rural healthcare. Recent awards to Louisiana, Nebraska, and Iowa illustrate how funding can support workforce initiatives, technology upgrades, telehealth, and expanded access to care. These investments create an opportunity to rethink how rural healthcare is delivered and how communities can sustain essential services.

As states put their plans into action, laboratory services should be part of the conversation. Investments in healthcare infrastructure should consider diagnostic capabilities, laboratory equipment, information systems, and the professionals needed to operate them. Workforce strategies should recognize laboratory medicine as an essential component of the rural healthcare team.

Funding alone cannot resolve every challenge facing rural healthcare. Lasting progress will require thoughtful policy, effective partnerships, and solutions tailored to individual communities. It will also require recognizing that a hospital’s ability to deliver care depends, in part, on the strength of the diagnostic services supporting it.

Rural healthcare is not simply a question of keeping hospital doors open. It is about ensuring that patients can receive the care they need, when they need it, as close to home as possible. Clinical laboratories are central to that mission. As the nation considers how best to invest in rural healthcare’s future, strengthening laboratory infrastructure and building a sustainable laboratory workforce must be part of the plan.

I welcome your comments and questions — please send them to me at [email protected].

REFERENCES

1. America’s rural hospitals at a crossroads. American Hospital Association. Accessed October 16, 2026. https://www.aha.org/americas-rural-hospitals-crossroads.

2. Giraldi DM, Garcia E, Kundu I, Famitangco RF. Disparities in rural health care: A look at the field of laboratory medicine. Crit Values. 2018;11(4):40-45. doi:10.1093/crival/vay035.

3. The quiet crisis: Navigating the clinical laboratory workforce shortage. Myadlm.org. Accessed October 16, 2026. https://myadlm.org/cln/cln-industry-insights/2026/navigating-the-clinical-laboratory-workforce-shortage.