; and (2) a program established in 1997 to support limited-service hospitals that, being located in rural areas of the United States that cannot support a full-service hospital, are critical access points to health care for rural patients; Whereas hospitals in rural areas of the United States achieve high levels of performance, according to standards for quality, patient satisfaction, and operational efficiency, for the types of care most relevant to rural communities; Whereas in addition to the vital care that rural health care providers provide to patients, rural health care providers are critical to the local economies of their communities and are one of the largest types of employers in rural areas of the United States where, on average, 14 percent of total employment is attributed to the health sector; Whereas a hospital in a rural area of the United States is typically one of the top 2 largest employers in that area; Whereas 1 primary care physician in a rural community annually generates approximately $1,500,000 in total revenue, and 1 general surgeon in a rural community annually generates approximately $2,700,000 in total revenue; Whereas the average Critical Access Hospital, a limited-service rural health care facility, creates 107 jobs and generates $8,400,000 in annual payroll, and the wages, salaries, and benefits provided by a Critical Access Hospital can amount to 20 percent of the output of a rural community’s economy; Whereas hospitals in rural communities play a vital role in caring for the residents of those communities and preserving the special way of life that communities in the United States foster