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Rural hospitals face mounting challenges due to economic disparities, workforce shortages, and outdated infrastructure, which hinder their ability to deliver high-quality care. This chapter examines the evolving landscape of rural healthcare, focusing on Critical Access Hospitals (CAHs) and the role of evidence-based design in addressing systemic issues in rural hospitals. Drawing on expert insights, post-occupancy evaluations, and case studies, the chapter explores how innovative facility design can enhance patient outcomes, staff efficiency, and financial sustainability. A comparative study of two rural hospitals in Kansas highlights the impact of design on operational performance and community engagement. The chapter also presents a prototype for a community-integrated rural hospital that revitalizes Main Street and fosters synergies with local institutions. Key strategies include flexible care spaces, shared work areas to allow cross-staffing, telemedicine integration, and community-based health initiatives. The findings underscore the importance of tailoring healthcare environments to the unique needs of rural populations and call for collaborative efforts among designers, researchers, and policymakers. Future trends emphasize outpatient care, digital infrastructure, and holistic approaches to community wellness. The chapter advocates for a paradigm shift in rural healthcare design–one that positions hospitals as central to the social, economic, and environmental health of their communities.