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Many rural residents have limited access to surgical care. Rural hospitals frequently struggle to provide surgical services due to workforce shortages and financial constraints. The purpose of this study is to describe rural hospital administrators' perceptions regarding the state of their general surgery programs and the impact that providing surgical services has on their hospitals' financial viability.A 12-item survey was mailed to a random sample of national rural hospital administrators (n=233). One hundred and eleven surveys were completed, yielding a response rate of 48%. In addition to overall descriptive analyses, comparisons were made between hospitals located in large versus small rural communities.Eighty-three percent of rural hospital administrators perceived their surgical program to be very important to the financial viability of their hospital and stated that they would reduce services if the hospital were to lose its surgery program. Thirty-four percent of hospitals have a surgeon leaving within the next 2 years and more than one-third of hospital administrators are currently searching for a surgeon.Surgical care is a vital component of the health care services delivered by rural hospitals. Surveyed administrators' view the ability to provide surgical services as crucial to the financial viability of their rural hospitals. A shortage of general surgeons is a potential major threat to these rural hospitals.