Some 60 million People in rural areas of the country rely on small local hospitals for medical care. But while the Delta variant rages on, the hospitals that provided a lifeline to these communities are now being deprived of the resources they supported: nurses.

A boom in demand for travel nurses working briefly in hospitals across the country to fill high-demand jobs has exacerbated a long-standing staffing problem as rural nurses are attracted by salaries that can be nearly 10 times their hometown wages .

Rural hospital nurses earn an average of $ 70,000 a year, or just over $ 1,200 a week. according to go to the ZipRecruiter settings website. But some recruitment agencies like Nomad Health are offer Travel nurse with a salary of $ 5,044 per week. White Glove Placement, another recruiting agency, offers Placements that pay between $ 5,800 and $ 5,900 per week. Healthcare vacancies Vivian Lists multiple travel nurses paying up to $ 9,562 per week.

Covid was uniquely suited to capitalizing on any break in the rural hospital workforce and significantly expanding it.

“If you lose a nurse or two, it makes a difference,” said Audrey Snyder, president of the Rural Nurse Organization advocacy and faculty member at the University of North Carolina Greensboro School of Nursing. “These hospitals are small hospitals and don’t have large nurses.”

Years of low patient numbers, a high number of uninsured patients and government-funded insurance payers led to a record number of hospital closures in rural areas last year, according to to the Cecil G. Sheps Center for Health Services Research.

Dozens of rural hospitals filed for bankruptcy last year, including the Eastern Niagara Hospital in Lockport, New York, the Faith Community Health System in Jacksboro, Texas, and the Pinnacle Healthcare System hospitals in Kansas and Missouri. Another 216 rural hospitals are currently at high risk of closure, said Brock Slabach, chief operations officer of the National Rural Health Association.

“The rural hospital staff has always been a challenge,” said Slabach. “What Covid was uniquely suited for was taking advantage of each fracture and widening it significantly and making it even more difficult to cope with the demands placed on it.”

Most of the demand isn’t even directly related to Covid patients, said Susan Salka, CEO of AMN Healthcare Services Inc., on a conference call last month. Rather, it is about “sick leave, fatigue of the clinic staff, normal patient numbers and backlogs in the operating theater. Our customers tell us that this is unlikely to change anytime soon, ”she said.

While the increasing popularity of travel nursing has exacerbated the country’s shortage of care, it has been a boon for recruitment agencies. AMN Healthcare Services Inc., a San Diego-based medical personnel agency, reported a 41 percent increase in revenue from the same date last year. The travel nurse business alone grew 37 percent, the company reported.

Cross Country Healthcare CEO Kevin Clark told investors on a conference call last month that travel nurse orders from clients of the recruiting agency rose nearly 50 percent over the course of the second quarter. Revenue for the travel nurse business increased 58 percent, he said.

“We are coming out of the pandemic, I think with flying colors,” he said. “First-time travelers have increased significantly this year. This trend continued in the second quarter. “

Many nurses turn to travel nursing primarily for payment, but also the opportunity to hone their skills and advance their careers, said Nicole Rouhana, director of the graduate nursing program at the Decker School of Nursing at Binghamton University. Rural nurses are considered jack-of-all-trades, she said. One night they could work in the emergency room and another night they could assist with a birth.

“[Travel nursing] is more popular right now and I think it’s partly because we’re also a mobile society and it’s attractive to go to Southern California and work six weeks and go to the northeast and work in the summer, “she said .

Rouhana, along with other nursing programs and clinics, has introduced new scholarships and short term educational experiences for nurses to learn new skills in a rural hospital setting in the hope that they will continue to serve the community. Some government programs cancel college debt for nurses who have worked in rural hospitals for a number of years. At the same time, healthcare companies are offering bonuses. Unity Health in Newport, Arkansas, elevated its $ 15,000 signing bonus for new bedside nurses. Monument Health in Rapid City, Iowa, is offer experienced nurses up to $ 40,000 to fill multiple nurse positions in the intensive care unit and operating room.

But smaller rural hospitals can’t afford to pay competitive nurses salaries, said Shannon Cannon, a professor at Texas Tech University School of Nursing. The counties where rural hospitals are located sometimes have just a few thousand residents, which means taxes are lower, she said.

“When you live in a community in rural west Texas with 1,500 to 2,000 people, it’s difficult to find a nurse in that community,” she said. “They are drawn to bigger cities because the pay is better and there are more attractions, especially for young nurses.”

Patricia Gonzalez Meserole, 50, has been a nurse in the rural city of Washington, Iowa for over 16 years and makes about $ 30 an hour. She says she was spoiled by the city’s quiet and small-town culture. But now she is looking for a position as a travel nurse that will give her the hospital experience she wants from a well-resourced institution and the salary she needs to stabilize her finances.

“It hurts my heart to tell my boss that she has to replace me because it’s hard to find people right now,” she said. “But this is my opportunity to use these skills and make so much money. My goal is to pay off debts and credits and build a future, because I can’t do that at the moment. “