Cost containment and the nurse shortage have impacted rural hospitals and their nursing staffs. This impact did not appreciably affect burnout levels among the rural nurses, but did evidence itself in the reports of the directors of nursing and their nurses. Cost containment brought with it layoffs of colleagues in the work setting who were neighbors or relatives. This occurred while the rural areas were already filled with the unemployed and underemployed. Unfamiliar recordkeeping increased two- and three-fold, and the 23-hour admit caused unequal work flow. Downsizing, elimination of some services and reports of rural hospital closings were threatening to the nurses, who were often the sole support of their families. The rural nurse shortage was seen to be different from the national nurse shortage in significant ways. Except for the few study hospitals that were close to population centers, nurses could not be recruited from outside the geographic area. Suggestions from the Secretary's Commission on Nursing are not all appropriate for the rural hospital nurse shortage. Rural hospitals changed in the face of cost containment, and nursing personnel also worked to contain costs. However the nurses have worked within cost and salary constraints for so long that they predict loyalty to their community hospitals can be coming to an end. The nurse shortage is being approached by minor alterations in staffing and mode of care delivery. Federal support is desperately needed by the rural hospitals to permit equitable salaries, and to support financial aid to permanent residents of the rural areas for entrance into or advancement in nursing education.(ABSTRACT TRUNCATED AT 250 WORDS)