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This optional C case follows S-0314 and S-0315, and describes the results of decisions on whether to allow a merger of two health care entities in rural Virginia. This case set explores the differences in and conflicts among the interests of for-profit health care systems, of rural, low-income residents, and of federal, state, and local governments. It allows students to engage in an in-depth discussion of the sometimes emotional issue of rural healthcare. It is suitable for students in a classes spanning health care management, nonprofit management, public policy, governance, ethics, and the social sector.