The share of Americans without health insurance fell from 15.5% to 8.6% since the Affordable Care Act was signed into law in 2010. While broader insurance coverage has improved access to health care for nearly 20 million Americans, millions more face a less discussed but no less serious hurdle — distance to the nearest hospital.

In instances of head trauma, lacerations, cardiac arrest, and child birth, every minute counts, and transit time to the hospital can mean the difference between life and death. Currently, more than 2 million Americans live in towns and cities located more than 20 miles from the nearest hospital.

Remote rural towns are often those farthest from a hospital, and many hospitals that serve rural areas are struggling financially. Over the last eight years, 87 rural hospitals have shut down nationwide — and hundreds more could be closed in the near future due to budgetary concerns.

According to the Centers for Disease Control and Prevention, travel distance to hospitals is one of many factors in rural communities that can increase the risk of premature death.

By reviewing 15,000 towns and cities nationwide, and measuring the distance from their geographic center to the nearest acute care facility, 24/7 Wall St. identified the city or town in every state located farthest from a hospital. We considered all areas, including boroughs, census designated places, cities, towns, and villages.

The distances to the nearest hospital in the cities and town on this list range from 471 miles for Unalaska, Alaska, residents to just 12 miles for Hope Valley, Rhode Island, residents. In some cases, the nearest hospital is in a different state.

It is important to note that distances represent a straight line from the center of the town to the nearest hospital. As such, actual travel distance by roadway will be even greater in every case.

Click here to see the towns in every state where you may not get to the hospital in time.
Click here to see our detailed findings and methodology.