Confused about "rural' status

[JSWANAHLP]

Anyone know what could make a city (the county seat that also has the highest population of any city in the county) classified as a "rural" area? That seems to be what has happened here and as a result we have lost 50% of our primary care physicians and nurses are stuck in a time-warped pay scale. I know nurses who are willing to travel 200 miles every day to work in a facility that will pay a competitive salary, because our city can't afford to. We have 2 hospitals and it seems that both are always on the edge of collapse. The 3rd hospital that had been here since 1897 and was the only facility that offered community care recently closed because they couldn't afford to keep the doors open. I don't get the "rural" as opposed to metropolitan difference except that our county is reimbursed at a lower rate than other areas with comparable demographics because of it.

Ten years ago this county used to set the bar in the state for how to operate a healthcare system. Now we can't even attract physicians or nurses. The 'rural' status has somehow left us off the radar of progress. So my question is: What does it take to become metropolitan? I mean, look in the dictionary and we fit the definition, much more so than 'rural'.

In the meantime, doors are closing. Primary care physicians are leaving and those that are dedicated to the community aren't being paid, or are being reimbursed after very long waits. I recently saw a letter from one of the few primary care physicians in town that states that although the average cost to run a practice like his has increased 15% in the last 5 years, in 2006 Medicare is still paying physicians the same rate as they paid in 2001 and at the end of 2006 there will be another 5% decrease in reimbursment if Congress does not step in. His hope is that enough of us will contact our congressional representatives to stop the 5% decrease. The only other way he can still practice is to stop accepting Medicare assignment and force patients to pay out-of-pocket, which most cannot afford and would make an already maddening Medicare billing system even more confusing to them.

I want to work here. This is where I was born & where I want to stay but I don't know how it can work w/ our housing and general cost of living increasing at an astonishing rate(3.45% this year, 5.8% last year(ConsumerPriceIndex)), yet the wages are the same as 5 years ago.

Can anyone shed some light on this for me?