Dartmouth Health CEO and President Joanne M. Conroy, MD, recently joined MaineHealth CEO Andrew Mueller, MD, and The University of Vermont Health Network (UVMHN) President and CEO Sunny Eappen, MD, MBA in a roundtable discussion about the extreme crisis in rural healthcare. The leaders of the largest healthcare systems in northern New England and the North Country of New York discussed what it means to be an academic health system, the workforce challenges, including recruitment, housing and childcare, as well as payer, regulatory and inflation challenges, and innovations that preserve and improve access to high-quality care. The purpose of the roundtable was to highlight the critical concerns, build awareness of the problems rural healthcare providers face across the country, discuss possible solutions, and draw attention to the fact that health systems like Dartmouth Health, UVMHN and MaineHealth cannot fix these problems alone.