A quarter of all rural US hospitals, most of which are highly essential to their communities, are at high risk of closing.Hospital closures may increase transport time and delay treatment. This column examines hospital closures in California from 1995 to 2011 to assess the effects of rural and urban hospital closures on inpatient mortality. Mortality increases after a rural hospital closure not only in the local rural area but in the neighbouring urban areas as well. This adverse effect is larger for Medicaid patients and racial minorities.