by Julia Sklar in National Geographic, updated December 2021

With fear of COVID-19 keeping many routine visitors away, rural hospitals have too few patients to stay afloat financially, and virtual medicine isn’t saving them.

To reach North Sunflower Medical Center from any direction, travelers must first drive through miles of open fields filled with cotton, corn, and soy. Eventually, they’ll land in the center of Ruleville, Mississippi, whose population of 2,800 is smaller than the number of monthly visitors the clinic sees ordinarily. Some patients travel from as far as 45 miles away to receive care here.

But the past couple months have not been ordinary. Since March, when the World Health Organization labeled COVID-19 a pandemic, almost 50 percent of North Sunflower Medical Center’s patients have stopped showing up.

This pattern is playing out across the country at both rural and urban hospitals: Fearful of the pandemic, non-coronavirus patients are staying home, despite suffering conditions ranging from minor rashes to major heart attacks.

In response, many hospitals have created ad hoc systems for delivering primary care through telemedicine, buoyed by the mantra: If patients won’t come to the hospital, the hospital will come to the patients.

Virtual health care, in theory, sounds perfectly suited to the needs of rural populations. It kicks down the barrier of traveling great distances for medical needs and works increasingly well for diagnosing and managing the chronic and non-emergency health issues endemic to these parts of the country, such as diabetes, hypertension, asthma, and melanoma.

Yet success at implementing these virtual systems has been a patchwork. Unreliable access to at-home technology, broadband internet service, and cell reception have plagued some places, while ever present financial hurdles abound.

Rather than usher in a long-anticipated telemedicine revolution in remote areas, COVID-19 has exposed its limitations, and highlighted what tools and regulations rural hospitals will need to survive the pandemic.