W ithstanding landmark legislation such as the Affordable Care Act and cutting-edge scientific advances in cancer diagnosis and treatment, rural residents in the United States continue to experience more frequent and higher severity of multilevel barriers to quality cancer treatment services including lack of access to guideline-concordant treatment. 1 The rural health care landscape in the United States continues to be plagued by financial distress, health care professional shortages, hospital closures, geographic isolation, and high chronic disease burden. 2 These issues persist despite a substantial increase in the number of hospitals designated as a Critical Access Hospital (CAH). In 1997, Congress created the CAH designation to reduce the financial vulnerability of rural hospitals and improve access to health care by retaining essential services in rural communities. 3 CAH must meet the following requirements to obtain CAH designation: (1) have 25 or fewer acute care inpatient beds; (2) be located > 35 miles from another hospital; (3) maintain an annual average length of stay of 96 hours or less for acute care patients; and (4) provide 24/7 emergency care services. 3 Despite increased numbers of CAHs, access to cancer care continues to be a challenge for rural areas, as suggested by the high cancer mortality rates in comparison to urban areas. [4][5][6] Patient, provider, and institutional level factors have been well documented as contributors to these disparate cancer outcomes. 7 Rural counties have some of the highest rates of poverty, where residents are faced with limited availability to cancer treatment and supportive care services, transportation barriers, and financial issues. [4][5][6][7] Importantly, while 20% of Americans reside in rural areas, only 10% of physicians practice there, and those delivering cancer care have limited access to comprehensive care service delivery models. 7 The challenge at the institutional level for CAH is multifactorial-lack of skilled health care workforce, financial constraints, patient volume, and space. Compositely, these challenges drive cancer health disparities and impede the advancement of health equity.In this issue of Medical Care, Hung et al 8 examined the availability of cancer treatment services across CAHs and Prospective Payment System (PPS) hospitals. Through the conduct of a retrospective, time-series analysis using data from 2008 to 2017 American Hospital Association Annual Surveys and multivariable logistic regression, the authors examined current cancer services changes over time and relevant differences between urban and rural hospitals under the PPS and CAHs. The independent variable was hospital type (urban PPS, rural PPS, and CAHs), and the dependent variable was the presence or absence of 2 therapeutic services (chemotherapy and radiation therapy). The results of the analyses revealed rural PPS hospitals and CAHs had lower rates of comprehensive oncology, chemotherapy, and radiation therapy availability over time. Although the differences in ch...