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This study examines healthcare disparities between rural and urban populations in the United States, highlighting rural residents’ challenges in accessing timely and quality healthcare. These challenges include geographic barriers, limited access to specialists, socioeconomic factors and cultural and linguistic issues. The study analyses the impact of these disparities on health indicators such as chronic disease rates, maternal and child health outcomes and mortality rates. It also explores contributing factors such as social determinants of health, access to preventive care and workforce shortages in rural healthcare settings. The research further investigates the relationship between patient service margin and hospital closures, assessing whether patient service margin serves as a predictor of closure risk. Using secondary data from Missouri hospitals between 2019 and 2022, the study conducted descriptive statistics and paired samples t-tests to evaluate financial performance. The findings reveal that lower patient service margins may indicate delivery challenges, access issues and threats to the viability of rural healthcare services. Financial results vary widely for patient service margins, and these consistently negative margins suggest that rural hospitals have faced financial challenges, impacting their capacity to provide high-quality treatment and access. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/ business/.