The abandoned Osceola Medical Center in Osceola, Wisconsin. Editorial credit: Sheena Waldron / Shutterstock.com.

Of the roughly 3,140 counties and county equivalents in the United States — a total that shifts depending on whether you count Louisiana's parishes, Alaska's boroughs and census areas, and Virginia's independent cities — 691 have no hospital inside their borders at all. That is 22 percent of them, according to Rural Hospital Data (RHT) Compass, which defines a "hospital desert" as a county with zero hospitals registered in the federal Provider of Services file. Residents of those counties drive into a neighboring county for emergency, trauma, and inpatient care, sometimes an hour or more from home. Texas has the most with 30 percent of its counties without proper care. Twenty-three states have at least ten. The gap widens for specialized care: more than half of U.S. counties lack a hospital offering labor and delivery services, per the March of Dimes.

Suburban Counties on the East Coast Lacking Hospitals

Most of the 691 are rural, but several sit on the edge of major metropolitan areas. In these places the problem is not a shortage of people. It is that the region's hospitals were built in an older core city and stayed there while the population spread outward across a county line.

Queen Anne's County, Maryland

One example is Queen Anne's County, Maryland, one of only three hospital deserts among Maryland's 24 counties. This growing suburban county, home to roughly 52,000 residents as of recent Census estimates, sits directly across the Chesapeake Bay Bridge from Annapolis, and has no inpatient hospital within its borders.

For years residents relied on care in Chestertown in neighboring Kent County — now the University of Maryland Shore Medical Center at Chestertown — a half-hour's drive away, or across the bridge into Annapolis. The county's answer was to send care out rather than wait for a building. Its Mobile Integrated Community Health program dispatches a nurse and a paramedic to the homes of residents who lean heavily on 9-1-1. It was the first of its kind in Maryland, has since been copied by Charles County, being evaluated at roughly $3.4 million in avoided costs for three years.

Greene County, New York

In the northern Hudson Valley, Greene County is one of five hospital deserts in New York. Greene County Memorial Hospital in Catskill merged with Columbia Memorial in the late 1980s and closed in the mid-1990s; its building now houses the Greene Medical Arts Center. Since then the county's roughly 48,000 residents have traveled north into Albany County, or across the Rip Van Winkle Bridge to Columbia Memorial Health in Hudson, for emergency and inpatient care.

Other New York counties with no hospital include:

Hamilton County — in the Adirondacks, home to about 5,100 residents, who travel up to an hour to Adirondack Medical Center in Saranac Lake or Glens Falls Hospital.
Seneca County — in the Finger Lakes, where roughly 33,000 people live and many thousands more vacation each year. Residents and visitors travel to Ontario County's Geneva General Hospital or Cayuga Medical Center in Tompkins County.
Tioga County — in the Southern Tier, with about 48,000 residents who rely on hospitals in Binghamton in Broome County, or in Chemung County.
Washington County — on the eastern border next to Vermont. Its roughly 61,000 residents travel to Glens Falls Hospital in Warren County, Saratoga Hospital in Saratoga County, or across the state line into Vermont for acute inpatient care.

Frederick County, Virginia

Aerial view of Winchester, Virginia, an independent city entirely surrounded by Frederick County.

Virginia has the second-highest count of hospital deserts in the country: 65 of its 133 county equivalents, or 49 percent. Much of that is a quirk of how the state is drawn: Virginia's 38 independent cities are county equivalents in their own right, so a hospital at the center of a region can sit legally outside the county surrounding it.

Frederick County is the clearest case with an estimated 91,400 residents noted in the 2020 census and has never had a hospital of its own, yet the 495-bed Winchester Medical Center, the region's only Level II trauma center, is four miles away in Winchester — an independent city entirely encircled by the county. The next nearest is Warren Memorial Hospital in Front Royal, about 20 miles off.

Hospital Deserts in the South and Midwest

The larger share of the problem lies across the nation's rural expanses, especially in the South and Midwest, which together account for all ten of the states with the most hospital-desert counties. The examples below are among the most populous counties in the country without a hospital.

Randall County, Texas

Of the 75 Texas counties with no hospital, Randall County is the most populous, with 140,753 residents at the 2020 census. It is also the strangest on the list, because it contains the southern half of Amarillo — the city straddles the Potter-Randall line, and every one of its hospitals sits on the Potter County side. The county once had its in the 1930s until it closed down in 1975.

Today, residents of Canyon — the county seat and the gateway to Palo Duro Canyon — drive about 16 miles north into Potter County for hospital care.

Fayette County, Tennessee

Ascension Saint Thomas Hospital Midtown in Nashville, Tennessee. Editorial credit: JHVEPhoto / Shutterstock.com

Tennessee has 24 counties with no hospital. Fayette County, with about 42,000 residents at the 2020 census, is one of them. It has been without a local hospital since 2015, when Methodist Fayette in Somerville closed under financial pressure with its parent system donating the building to the town, that was later turned into a University of Tennessee at Martin satellite campus.

Somerville residents now drive between 26 and 35 miles to the closest hospitals, in Bartlett, Collierville, and Germantown. However, relief is currently under construction with the Baptist Memorial Hospital in Fayette County. The $27 million facility will have eight emergency beds, eight inpatient beds, and is scheduled to open near Somerville in spring 2027.

Franklin County, North Carolina

Downtown Louisburg, North Carolina. Indy beetle, CC0, via Wikimedia Commons.

Franklin County is the most populous of the 23 North Carolina counties without a hospital, and one of the fastest-growing: 68,622 residents at the 2020 census, an estimated 79,771 by 2024. Its only hospital, Novant Health Franklin Medical Center in Louisburg, closed in October 2015 after years of declining use, averaging eight patients a day in a building licensed for 83 beds.

However, the county is not without emergency care. In 2018 the same building reopened as Maria Parham Franklin, a freestanding emergency department with round the clock staffing, imaging, and a 13-bed geriatric behavioral health unit. It runs under the license of Maria Parham Health in Vance County, which is why the federal count still registers Franklin as hospital-free. For acute inpatient care, residents travel up to 30 miles to WakeMed in Wake County or Maria Parham in Vance.

Christian County, Missouri

Missouri has 47 counties with no hospital, 41 percent of the state's total. Christian County is one of them, despite holding just under 90,000 residents at the 2020 census and containing two of the region's fastest-growing suburbs, Nixa and Ozark. There is no acute care hospital with an emergency room anywhere and its ambulance district is dispatched from Greene County by CoxHealth EMS in Springfield.

For the northern half of the county the drive into Springfield is short, but for the rural east and south, some of it without reliable transportation, it is a good deal longer.

Cass County, Nebraska

Nebraska has 27 counties lacking hospitals, among them Cass County, population about 26,000 at the 2020 census. The county sits between Omaha and Lincoln, and the major health networks have concentrated their facilities in those two cities.

For residents of Plattsmouth and the eastern edge of the county, that arrangement works reasonably well. Yet for the rural west and south, it means a long drive to Bellevue or Omaha for anything an outpatient clinic cannot handle.

Counties Without a Delivery Room

A hospital desert and a maternity care desert are not the same thing. The March of Dimes counts a county as a maternity care desert only when it has no birthing facility and no obstetric provider of any kind, and by that measure 34.6 percent of U.S. counties qualify, home to 2.4 million women of reproductive age and about 149,000 births a year.

They are not evenly spread with 38.7 percent of counties in both the South and the Midwest qualify, against 26.4 percent in the West and 5.1 percent in the Northeast. Rural counties carry the weight, with 57.9 percent lacking a practicing obstetric clinician against roughly 19 percent of urban counties. And the map keeps moving — 96 labor and delivery units closed across 35 states between January 2024 and May 2026.

Lowndes County, Alabama

East Montgomery Imaging Center, the primary medical imaging center in Montgomery, Alabama. Editorial Credit: Mccallk69/ Shutterstock.com

Lowndes County, Alabama, has never had a standalone maternity hospital or a community hospital with an obstetric unit. For its roughly 10,300 residents, the nearest one is a 45-minute to one-hour drive to Montgomery — a trip the March of Dimes has used as a case study, citing a Lowndes County mother who, sent home in early labor, rented a hotel room near the hospital rather than risk making the drive twice. More than a third of Alabama's counties are maternity care deserts.

Greenbrier County, West Virginia

Greenbrier Valley Medical Center in Ronceverte delivered its last baby in April 2026, ending obstetric care not only for Greenbrier County's roughly 33,000 residents but for the five-county area the unit served. Owner Vandalia Health closed the unit as the hospital converted to Critical Access status, saying it had tried without success for two years to recruit an obstetrician.

Prenatal care continues locally but delivery does not. The closest options are Beckley, an hour away, or Charleston, closer to two. It is part of a longer slide where a decade ago, 26 West Virginia hospitals delivered babies, and by 2026 the number was 18.

Barron County, Wisconsin

Barron County, Wisconsin, lost its last hospital birthing option on August 26, 2022, when Mayo Clinic Health System — Northland in Barron transferred labor and delivery services to Eau Claire, about 50 miles south, citing its inability to keep an OB-GYN on staff. Prenatal, postpartum, and gynecological care continue there. Roughly one in seven of Wisconsin's 72 counties is a maternity care desert, better than the national average, though travel times across the center and west of the state have climbed sharply as rural hospitals and clinics have closed.

Cecil County, Maryland

Cecil County, Maryland, population about 103,700 at the 2020 census, lost its only birthing center on June 30, 2026, when ChristianaCare closed the Family Birth Center at Union Hospital in Elkton. The hospital itself remains open, but the maternity ward does not. ChristianaCare cited an aging community, falling delivery volumes, and years of failed obstetrician and pediatrician recruitment, and has been transporting patients at no cost to Christiana Hospital in Delaware, 13 miles away.

The other option is UM Upper Chesapeake Medical Center in Harford County, 45 minutes to an hour from most of Cecil. County leaders say a replacement unit is at least 18 months away.

Looking Towards the Future

A county without a hospital is a county operating without a safety net. Behind the statistics are families mapping the route to a delivery room weeks in advance, and residents counting the minutes it takes to cross a county line during a heart attack. The counties above are not remote outposts — several are among the fastest-growing places in their states. Any honest measure of medical progress has to include how fast care reaches the people living farthest from it.

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The Counties With No Hospital