I think it's just a natural realignment. Urgent cares take a lot of the hospitals action. Pretty much everyone can afford a decent car and knows that the better hospital isn't the rural one. Expanding ambulance and air evac is a big thing right now. Even in urban and suburban settings you are still dealing with fair travel times to hospitals. If you can get decent ambulance, air ambulance, and urgent care there's really not as much of a need for rural hospitals.