National attention on the financial vulnerability of Critical Access Hospitals (CAHs) and rural hospitals and their risk of closure is not a new phenomenon. Rural hospitals have long struggled with chronic workforce shortages, high operating and staffing costs, inadequate reimbursement, operational and regulatory issues, and the diverse demographics of rural communities. CAHs and rural hospitals are also challenged to adapt to an evolving health care environment with a declining need for inpatient beds, increasing competition by non-hospital and non-traditional providers, changing care paradigms, and a growing adoption of value-based payment models. There is an extensive history of efforts to support small rural hospitals in response to prior waves of closures, dating from 1973 to the present. This paper summarizes state and federal programs, demonstrations, and models to support CAHs and other rural hospitals. Grouped by program characteristics, the summaries provide lessons learned to inform current policy discussions, describe the trends driving the various waves of rural hospital closures, and explore trends likely to impact CAHs and other rural hospitals in the foreseeable future.