When I was a resident in emergency medicine, at what was then simply Methodist Hospital of Indiana, I was blessed with the opportunity to fly with Lifeline. While I am originally from West Virginia, where rural means mountainous, I came to love the beautiful, stark emptiness of Indiana as seen from the sky.  And over time, I came to truly appreciate the small, rural hospitals that called us for help at all hours of the day and night.

I wish I had a log of all of the towns and facilities we visited by air, landing in remote helipads on winter days, or on lonely road-sides in the frantic, alcohol soaked days of summer car crashes.  Those scenes remain with me, and always will.  From farm accidents to burns, cardiac events to electrocution and everything in between, I came to appreciate the sense of loneliness, the sense of anxiety in the eyes of first responders and even physicians in remote areas.  It was wonderful to be able  to come to the aid of both providers and patients.  Not because the providers were inadequate.  They were just doing hard work in places with fewer resources.  And we were the cavalry.

It seems, however, that my actions were almost a prophecy of my future.  I spent twenty years working in rural South Carolina, being the guy in a fairly busy small emergency department who called helicopters; for trauma, burns, MI, ruptured aortic aneurysms and all the rest.  Sometimes the best thing in all the world was watching that helicopter lift off, then turning back inside to clean up and finish the paperwork.

But now I’ve taken another step. Moving further out and away, I’ve started a career in locums medicine.  And I find myself in ever smaller hospitals, in ever smaller towns.  And some of that work has brought me full-circle back to Indiana.  My Leap ancestor, buried just north of Indianapolis in the early 1800s, is smiling down on me, farmer and vintner and soldier that he was.

I love what I’m doing because as I get older, and travel the back-roads more and more, I see how vitally important small hospitals are to the communities they service.  And this is nowhere more true than in Indiana.  Despite the wonderful cities and towns of Indiana, it is a very rural place, and its people are tied inextricably to the land, the farms, the factories … and to their own ancestry in this former frontier, which retains some of the same expanse and emptiness of its past.

The small hospitals in the small towns of Indiana (and indeed many states) were born out of a kind of pioneer expediency, in which the local doctor in the local facility cared for the people he loved in the place he loved.

However, those places are in danger. In America today, there is a tendency for hospitals to form large conglomerates. In the complexity and competition of modern medicine, in which a vast bureacracy and huge corporations struggle for dollars, it’s no wonder.  But it raises costs all around.

Unfortunately, one of the side effects of those costs is that it is harder and harder for small hospitals to compete.  It is likely many small facilities will close in the not-too-distant future.  This is an eventuality that many in urban areas don’t really understand.  For them, hospitals compete.  There’s always another one within 15 or 20 minutes at most.  But for those in rural areas, their wee hospital, in the old building, is more than a hospital. It’s a mission post.  It’s a fortress of safety for their sick children or injured spouse.  It’s the only game in town.

That’s something I’m seeing more and more, and saw these 20 years past in residency.  The small hospitals of America, whether in Indiana, South Carolina, Kentucky, Illinois or anywhere else, all matter.  It matters that they have funding for talented and qualified staff, that they have help from larger centers in transfer agreements, that they have funding (and helipads). It matters that they remain open.

To this day, I lack a crystal ball. But I do know that our country, and every state in it, has to do its best to save the small hospitals of the land.  The places where ranchers and farmers, factory workers and loggers, sportsmen and miners and all the rest (and their precious families) live and work.

They may be in “flyover country” to some. But I’ve flown over it, and landed in it, and seen the sick and dying there.  Those folks deserve the same healthcare as everyone else.  And we can’t let anyone forget it.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test.  This article originally appeared in the Indiana Rural Health Business Partner Network.