The back wing of Bamberg County Hospital resembles a ghost town. New paper room numbers taped on doors, but no patients inside. Chart notebooks in the nurses? station, but no notes in the books, and no nurses. The 1950s-era tile floor is spotless, in part because few shoes hit it. That wing of the financially struggling hospital looks a lot like the state of rural hospitals in South Carolina. Many of the state?s 30 rural hospitals, once the heart of their communities, are struggling to find a niche in a health care system that values the complicated procedures offered at large hospitals much more than the basic and emergency services provided by rural hospitals. Less than half the beds in those 30 hospitals were filled on an average day from 2007-09, according to a Medicaid/Medicare study. Their occupancy rate dropped by 8% during that period. Ten of the smallest 13 hospitals operated at a financial loss in those years; the seven smallest lost $34.5 million. Rural hospitals are caught in a vicious cycle. They don?t have the customer volume to help pay for new technology and facilities that might lure specialty physicians to rural areas. But without those specialists, the hospitals can?t perform the procedures that bring in the most money to pay for new technology and facilities.