Rural residents within the United States were already at an economic disadvantage before the current recession hit. During the 1980s in states located in the northwest region of the United States, specifically Idaho and eastern Oregon, well paying labor and manufacturing jobs were lost (USDA, 1992), leaving behind higher poverty rates, aging populations, and increased challenges accessing quality health care (NSL, 2002). This editorial explores needs, quality and access to health care for rural citizens during our current time of economic instability.