Brad Huerta found himself vacuuming the halls of his rural Idaho hospital last week.

As the CEO of Lost Rivers Medical Center, in Arco, Idaho, it’s not his normal job, nor is it normal for the maintenance staff to be directing traffic of patients coming in with symptoms outside, or having the emergency department doctors take on extra shifts to fill in as nurses.

But rural hospitals trying to stay afloat in the middle of the coronavirus pandemic are a long way from normal. Often underfunded, understaffed and undersupplied, they’re now facing the looming impacts of COVID-19.

“A lot of small hospitals, they may have 15 to 20 days cash on hand. They’re trying to make payroll when things are good. Being asked to lay out all this additional expense while at the same time, enacting infection control measures and limit our regular operations… coronavirus is taxing us to the absolute limit,” Huerta said.

Because rural areas have so far been largely spared the infection rates found in major cities like New York, health care providers in smaller communities have had more time to prepare. But with limited financial resources, the impact may still be devastating.

“Think about what this is going to be in the long term impact to our operations at our hospital… while we understand federal relief is coming to our industry, it may only cover a small percentage of the significant losses,” Angie Foster, the Chief Nursing Officer at Evanston Regional Hospital in Wyoming said.