While the financial challenges of Critical Access Hospitals and the spate of rural hospital closures have recently garnered national attention, hospital financial crises date back to the mid-1980s. The historical similarity between contemporary financial struggles faced by rural hospitals and those of the mid-’80s may prove instructive in addressing problems like shortages of health care providers and trained EMS, or poorly fitting reimbursement policies. In this project, the Flex Monitoring Team will identify lessons from past state and federal rural hospital support efforts to inform current policy discussions.