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In this April 25, 2014 photo, a pedestrian crosses South Dooly Street in the main business section of Montezuma, Ga. Hospitals are under financial pressure everywhere, but the problems are compounded in rural America. There are fewer patients than in cities and, logically, fewer customers to pay for a hospital’s costs. According to a 2010 U.S. Census report, the population of Montezuma has decreased by 13.5 percent since 2000. (AP Photo/David Goldman)