An Open Letter: To the Rural Hospital CEO Who Is Still Fighting

June 2026 • From Karthik Ganesh, CEO, OnMed


‍Dear Fellow Healthcare Leader,

‍Running a rural hospital is one of the hardest jobs in American healthcare. You wake up managing margins that don't close, positions you cannot fill, and a community that depends on you for things that go well beyond clinical care. You are the safety net, the employer, the anchor. And you do it knowing that 182 hospitals just like yours have closed since 2010 — and that 432 more are considered at risk right now. Nobody hands you a playbook for that. You figure it out, year after year, because your community has no one else.

I see you. And I want to tell you something I genuinely believe — you are sitting on an opportunity that most people in your position haven't fully seen yet.

The challenge you cannot solve from inside your four walls is proximity. The people who need you most are not coming in. Not because they don't trust you — they do, more than any institution across the counties you serve. But the distance is too far, the wait too long, the system too unfamiliar. A woman in West Alabama had not seen a doctor in 20 years. Not because she didn't need one. Because no one ever showed up close enough. When we placed a CareStation inside a local school — eight feet wide, ten feet long, plugged into a wall — 48% of the surrounding community used it. She was one of them. She stopped a member of our team and said, "thank you for changing my life."

That is what happens when you meet people where they are.

78% of rural patients who use our CareStations tell us it is their only source of care. Not a supplement. Their medical home. 49% have chronic conditions that were unmanaged — not because they couldn't be treated, but because access never reached them. And 58% tell us that without the CareStation, they would have gone to the emergency department. Your emergency department. For something that should have been handled in primary care, long before it became a crisis.

CareStations with your brand and as an extension of your facility triage your community before they reach your doors. Low-acuity visits get resolved where they start. Higher-acuity patients get identified early, navigated directly to your facility, and arrive with context — not as walk-ins who have been deteriorating for months with nowhere to go. That is your revenue engine running the way it was built to run. The patients who need hospital-level care come to you. The ones who don't stop leaking to a system two counties over. No new brick and mortar. No capital expenditure. No recruitment risk. Just your hospital, extended into every corner of every county you serve — working for your people and your bottom line at the same time. And right now, $50 billion in the Rural Health Transformation Program exists specifically to help you move. Washington finally caught up to what you have known for years. The question is who acts first. Your brand extends deeper across every county you serve. And the people who have been invisible to the healthcare system finally have a medical home — one that carries your name.

Here is what I am really asking you to consider. You have spent years holding something together under enormous pressure, with not enough resources and too much at stake. That is not the whole story. The other part of the story — the part that gets written from here — is the rural hospital CEO who looked at a broken model and decided to do something different. Who took the trust their community had given them for decades and deployed it across every county they serve, not just inside one building. Who became the person that finally closed the gap.

That is the cape. And it fits you.

I would love to show you what this looks like across your region. Reach out. Let's build something your community will feel for a generation.


With respect and purpose,

Karthik Ganesh
Chief Executive Officer, OnMed


OnMed CareStations are deployed today in rural counties, correctional facilities, homeless shelters, senior centers, educational institutions, and underserved communities across the country. Healthcare Anywhere.