Care will be in shorter supply, travel distances will stretch farther, and high-risk situations will more likely result in tragedy. Rural mothers and newborns face significantly higher mortality and complications compared to urban areas, while federal actions may deepen these disparities. This dynamic signals a structural challenge in the availability and quality of maternal care in rural counties nationwide. Between 2016 and 2019, maternal mortality was 81 percent higher in rural areas, with rural women nearly twice as likely to require hospital transfer during or after birth. Since 2005, 109 rural hospitals have closed, and over the past five years more than two per month shuttered labor-and-delivery units.