“…In many communities, the hospital is the community. Few understand rural hospital challenges better than Jeff Spade, featured in this issue's Tar Heel Footprints in Health Care column [20]. During his tenure at the North Carolina Healthcare Association (formerly the North Carolina Hospital Association), Spade helped establish the Center for Rural Health and facilitated North Carolina's participation in the national Critical Access Hospital Program in 1998, supporting the conversion or designation of small rural hospitals and introducing enhanced reimbursement [20].…”