Raju pleaded with the hospital's owner to keep it open a few more days.

Ultimately, the hospital closed that Friday, leaving the rural town without a hospital for miles. Raju, who had been the hospital's chief of staff, is now the only doctor left in the town a two-hour drive south of Atlanta.

"I was very devastated when the hospital was closed," Raju said. "I was so attached to it. I practiced there for 33 years."

Raju knew that Richland's Stewart-Webster Hospital was "financially strained." Even for those patients covered by Medicaid, low reimbursement rates did not make a big enough dent. But Raju did not turn away any patients, even if they couldn't pay, he said.

Rural hospitals take a financial hit when they provide care to uninsured patients who can't afford it, said Elehwany. By insuring poorer patients, the Affordable Care Act hoped to remedy that. Despite its positive impacts, she said, it wasn't the magic bullet rural communities had hoped for.

"We strongly support the goals of the ACA," Elehwany said. "Everybody admits there's a few problems with the ACA, and unfortunately ... they seem to be magnified in rural America."

Sen. Shelley Moore Capito, a Republican from West Virginia, came out against the Senate health care bill this week for these reasons.

The Senate bill could cut revenues to rural providers by $1.3 billion each year, according to the Chartis Center and its partner iVantage Health Analytics. Roughly 34,000 jobs are also at risk, according to the analysis.

Raju, who sees 20 to 25 patients a day in his office, is not optimistic that hospital doors will reopen in Richland.

"I'm very doubtful it's going to happen, but we're not going to give up. We'll keep trying," he said.

That leaves his patients in what is known as a "medical desert." A long drive to the nearest hospital -- 45 minutes or more -- could be the difference between life and death, he said.

"Time is essential," he said. "We're going to lose some patients on the way because they cannot get the care in a reasonable amount of time."

But that doesn't deter Raju, who has been a staple in Richland for nearly four decades.

"I grew up in a rural area in India, and I always liked the small town," he said. "I've been here too long. I just can't go."

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Health care cuts: Rural hospitals 'hanging on by their fingernails ... - CNN