Meachael Goney worked at the Jamestown Regional Medical Center in rural Tennessee for 46 years, but that wasn't long enough to guarantee her job security.
"They just called us up to get our checks ... and said they were having a cutback," Goney told ABC News, having just been laid off from the hospital that was in the midst of deep financial troubles.
In May, the federal government stopped sending the hospital reimbursements for treating patients on Medicare and Medicaid. In an attempt to turn the hospital's prospects around, a new CEO, Michael Alexander, was named. Not long after ABC News' Steve Osunsami visited the center for "This Week's" Critical Care health care series, a note was posted on its doors saying they were temporarily closed.
The county was left without a hospital. The next two closest hospitals are between 45 minutes and an hour-long drive away.
Across Tennessee alone, a dozen rural hospitals have closed since 2010, and, according to an analysis by The Tennessean newspaper, more than a dozen others are at serious risk of going under. But it's not just a problem for Tennessee. In the last decade, more than 100 rural hospitals have closed across the country, according to the University of North Carolina's Cecil G. Sheps Center for Health Services Research. And an analysis by the management consultancy firm Navigant found that 21% of rural hospital in the United States are in danger of closing, too, if their finances don't improve.
Rural hospitals face a variety of challenges. They tend to serve aging communities that suffer from poor health and require expensive treatments. There are often severe doctor shortages in rural areas, and gaps in insurance coverage if patients have insurance at all. And, several studies show that rural hospitals are closing at a faster rate in states that chose not to expand Medicaid coverage to poor residents under Obamacare.
Tennessee is one of those states, and the residents of Jamestown and its neighboring communities fear losing their hospital could cost lives.
"If something happened to our children -- we live on a farm and farm machinery and snakes whatever. I've always just known that hospital's there if we need it," Tracy Wright, a churchgoer, said of the Jamestown center.
"Do you worry people wouldn't make it (to the nearest hospital in time)?" Osunsami asked Marilyn Hull, a retired nurse who used to work at Jamestown Regional. She suffered a heart attack in 2012 and worries about having another one and the hour-long drive she'd have to make if she did.
"Oh absolutely," she said. "I said before I think that a lot of people are going to lose their life over this."
Jamestown Mayor Lyndon Baines told ABC News that the town has pleaded to both the state and federal government to help keep the hospital open.
"We went to the governor, we called people in Washington, and there's nothing we can do until they settle the bill," he said.
A spokesperson for Tennessee Gov. Bill Lee told ABC News in a statement, "Governor Lee has advocated for the modernization of health care in Tennessee to improve affordability and access. Our rural hospitals have experienced a high rate of change in recent years and the Lee Administration is building transformative solutions through the Governor’s Healthcare Modernization Task Force and the Tennessee Rural Hospital Transformation program."
The parent company for Jamestown Regional Medical Center says the hospital’s financial woes are exacerbated by a large patient population that is uninsured or relies on government subsidized health insurance. They say hospitals closer to bigger cities treat more patients with private insurance that reimburse hospitals at a higher rate.
Tennessee's Labor Department is investigating claims that the hospital was withholding money from employees' paychecks, but not sending it to the state or Internal Revenue Service.
Alexander, the new CEO for the Jamestown Regional Medical, told ABC News in a statement that despite the allegations of mismanagement, "We're doing everything we can to try and stay open."
Last month, the federal government said it was considering new rules that could potentially give rural areas higher reimbursements for patients with government insurance, but if that money does come, it could be too late for the people of Fentress County, Tennessee.
Osunsami asked Jamestown’s mayor what his biggest concern was about emergency care.
"It’s just like accidents, or you know like tornadoes, something like that happens here," Baines said. "We do get 'em here, and it could happen at any time, and then what are we gonna do?"
That's a reality the people of Celina, Tennessee, have been living in for months.
The last hospital in the county, Cumberland River Hospital, closed in March, forcing residents to have to drive long distances to get emergency medical care.
"It was sad. It was the saddest day I’ve had since I’ve lived here," resident Roberta Profitt told Osunsami of the day the hospital closed. "And you know what? If you wasn't crying, you weren't human."
"It was really tough," Dr. Jessie Copeland told Osunsami, with tears in his eyes. "The first week or two coming by with the barricades up and it closed, still tough, but I mean you go on."
Copeland returned to the area after going to medical school and never left. He’s one of the only remaining doctors in the area.
"Being a doctor's office in an area with no hospital, no E.R., we do the best you can," he said. "Right now in this entire county, you can't get an X-ray of your ankle ... now it's an hour drive to go over and back to the hospital just to get an X-ray."
Natalie Boone, the director of Clay County Emergency Management Agency, said her four ambulances have become the new emergency room.
"We have become their first line of health care," Boone said. "Don't get me wrong, there's a lot of things that we can do in the back of these ambulances. But we're not an E.R. We can't take the place of the E.R."
"There are so many other neighboring communities going through the same thing right now," Clay County, Tennessee Mayor Dale Reagan said, and Copeland said it's an uphill battle.
"It's a fight every day to get the patients what they need."