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Imagine you’re having a heart attack and the nearest hospital is almost an hour away.

That’s a situation some of the 46 million Americans who live in rural areas could find themselves in, according to the Centers for Disease Control and Prevention. They’re more likely to die than someone who lives in an urban area due to having limited access to emergency services and specialized care.

wanted to see first-hand what this challenge looks like, so we visited Elberton, Georgia, which bills itself as the “Granite Capital of the World.” The town with fewer than 5,000 people sits a couple of hours east of Atlanta near the South Carolina border.

Cicadas chirped loudly as we made our way inside the Medical Center of Elberton

Office manager Brooke McDowell said they don’t quiet down, not even at night.

The center is officially designated by the government as a 

, which means it can get more money for treating people with Medicare and Medicaid. About 70% of the center’s patients fit that profile.

The clinic offers services like primary care, gynecology, X-rays and chronic disease management. Dr. Dan McAvoy, who sat with us for an interview, said the clinic has six physicians and two nurse practitioners.

“Probably the most common things we handle are hypertension, diabetes, heart disease, stroke,” McAvoy said.

If not for this clinic, he said, most people would have to go to cities that sit 30 to 40 miles away. That can be a barrier for some patients, McAvoy said, because they don’t have transportation available to them.

Beyond that, many rural hospitals have been closing across the country. From 2010 to 2019, 114 closed or cut key services across the U.S., 

. Closures are concentrated in states like Georgia that haven’t expanded Medicaid, the joint state and federal program that provides health coverage to low-income people.

In Georgia specifically, 18 of its 30 rural hospitals are at risk of closing due to financial issues, 

 from health consulting firm Chartis. The report also found that about half of all rural hospitals in the U.S. are operating in the red.

For 72-year-old Sylvia Chapman, this clinic means access to health care near her home — and a chance to tell jokes

“Why do melons get married?” she asked us and waited for a guess. “Because they cantaloupe.”

Chapman retired after 34 and a half years in public service and moved to Elberton seven years ago. She’s been a patient at the clinic for six years and she likes it here. “They let me tell my jokes. They tolerate me, so that’s not bad,” she said.

She’s had a couple of strokes, and every now and then, she needs to see specialists. The medical center helps her with referrals, and she likes her doctor. She’s also able to visit the nearby Elbert Memorial Hospital.

Where would she go if this clinic wasn’t here?

Athens, Georgia, takes her about 50 minutes to get to, or the town of Anderson, which is slightly closer but across the state line into South Carolina.

Would she skip care if what she needed was farther away?

“It’s easier to come here,” she said, adding that she would travel farther if needed. But the headache would be her husband’s because she rarely does any of the driving. “Whenever I tell my husband I have an appointment, he says, ‘Where is it?’”

He’s relieved to hear when they’re in town.

“You need this. You don’t need to get rid of this place,” she said, of the Medical Center of Elberton. “You have too many people in the waiting room, so you know it's a needed place. Very convenient for the locals.”

The local need is highlighted in Dr. Jonathan Poon’s schedule: It’s early May and he’s already booked out until July

It’s not a good feeling, Poon said, because he doesn’t want to be inaccessible to his patients.

“We will see, you know, our patients walk in without appointments any day. We'll work them in,” Poon said. “But it's just not a good feeling when someone calls and they have to wait for a month or more for appointments.”

It's a balance, Poon said, because he wishes he could spend more time with patients.

“But the more time we spend with patients means the fewer patients you can spend time with,” Poon said.

“Maybe I can’t clone myself, but if we can have more providers to help see our patients who have the same passion we do, that would be a great start,” Poon said.

That will be a challenge the clinic will have to grapple with sooner than later.

“Particularly, as some of us are aging, there’s going to be a need in the next few years for more physicians,” McAvoy said.

But it’s difficult to get doctors to move out this way.

“We have to find someone who likes the lifestyle of living in a small community and enjoys outdoors things, such as fishing and hunting,” McAvoy said.

Poon told us that one of the medical services most lacking here is mental health care

Poon said he and other doctors here have noticed mental health needs have become more of an issue over the past few years, but the clinic is limited in what it can do.

“We just don't have really a stable mental health program here,” Poon said. “And so we'd like to, you know, ultimately offer that ourselves. But there's no real, kind of, direct way for rural health to offer that.”

Georgia ranked 49th in access to mental health care and first in prevalence of mental illness in the 

, a nonprofit that works to provide resources and advocates for more access.

, the executive director of the National Alliance on Mental Illness for Georgia, why access is such an issue here.

She said that federal law requires insurance companies to provide mental health care at the same level that they do for physical health. Her organization has found that isn’t happening in Georgia.

But it’s also something people are uncomfortable talking about.

“I think there's just this overall stigma that mental health is maybe more so based on your behavior and your beliefs and pull up your bootstraps and just get over it. Versus it truly being a physical chemical imbalance in your brain at times,” Jones said.

With access overall in Georgia already a challenge, Jones said rural towns and counties fare even worse.

“There are a significant number of counties here in Georgia that have no mental health providers at all,” she said. “And so, even when we look at trying to expand telehealth, we have areas that are not covered by the internet.”

Despite the challenge of accessing health care, Sylvia Chapman tells us why this small town life appeals to her.

“I don’t have to fight traffic in the metro areas,” she said. She’s enjoying her retirement, playing games and puzzles on her phone. She and her husband will celebrate 47 years of marriage later in August.

She’ll keep coming to this clinic for her health care

She’ll also be watching the November election.

As someone who spent her working life helping Georgians get Medicaid, she recognizes the importance of health care as an issue.

“People are deciding whether to buy groceries or buy medicines. And that's the same problem we had back in the seventies and eighties,” Chapman said, adding that how people vote in November will be “very important” in deciding if Americans continue to face that challenge.

Obed Manuel

Author

A Martinez

Milton Guevara

Adam Bearne

Rural health care in the U.S. is facing a crisis. We visited a town in Georgia to see how some people are getting health care and to hear from providers about what they need to fix it.

Rural U.S. health care is in a crisis. We went to a Georgia town to see how people there experience it

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