As a result, leaders have considered closing PMH several times. The most recent conclusive consideration dates back to 2010 (Pocahontas Memorial Hospital, 2014). Furthermore, income from patient services is often negative (HCA, 2012). However, PMH's financial position is expected to improve since West Virginia recently expanded Medicaid. Furthermore, the healthcare sector suffers from staff shortages. Unfortunately, the shortage of health care workers is most severe in rural areas (National Conference of State Legislatures [NCSL], 2016). The per capita ratio of rural to urban providers is 0.42 for physicians, 0.66 for NPs, and 0.91 for nurse practitioners (National Center for Health Workforce Analysis, 2012). Compounding the problem, the rural population aged 55 to 75 is estimated to grow by 30% by 2020 (NCSL, 2016). Staff shortages will perpetuate barriers to entry and will be especially difficult for rural organizations to overcome due to limitations