Garrison Memorial Hospital sees 1,400 to 1,500 people in its emergency room annually. That is up about 20 percent over the last three to four years. Tioga Medical Center patient numbers have increased fourfold, from 6,000 patients in 2010 to more than 24,000 today. To meet this new demand, investments are being made in rural health care across the state, in areas where those facilities are the only medical care available for miles around. "We're the only hospital on (U.S. Highway) 83 between Minot and Bismarck," Garrison Memorial Hospital Administrator Tod Graeber said. "Because we're so far away from the larger cities ... with strokes or heart attacks people may not survive."