If you’re a fan of the PBS smash hit period drama “Downton Abbey,” I hope you’ve taken notice of one of the plotlines in the sixth (and final) season, now airing in the United States.

The plotline in question involves those storied rivals, Isobel Crawley (played by Penelope Wilton) and the Dowager Countess (played by Dame Maggie Smith). 

In the first two episodes, Violet, the Dowager Countess, and Isobel are at odds over whether the village hospital should be taken over by the larger county hospital. The time and the place portrayed may be 1925 Britain, but similar discussions are underway in more than a few boardrooms in 2016 America. What’s more, many of the arguments on both sides may sound familiar if you are either a trustee or a member of the C-suite.

As the Dowager Countess might say, there’s never a dull moment when you’re on a rural hospital board.

This month's Hospitals & Health Networks cover story discusses the challenges facing trustees of rural hospital boards, and how they are meeting those challenges head on.  Check out the “Framing the Issue” sidebar in the article — you might nod your head in agreement as you read the five bullet points listed.

As Tom Bell, president and CEO of the Kansas Hospital Association, tells the cover story’s author, Julius A. Karash, “I don’t think there is a more difficult or challenging volunteer job right now than being on the board of a hospital.” 

While trustees at rural hospitals traditionally may have come from white-collar backgrounds (i.e., business professionals, lawyers, bankers, etc.), Tim Putnam, president and CEO of Indiana-based Margaret Mary Health, notes that farmers also should be on the list of potential trustees. As he tells Karash:

“In small communities, farmers are great. Because one thing farmers know is how to adapt to odd government-payment programs. I’ve learned a lot from farmers I’ve worked with on the board.”

So, what tools are at a rural trustee’s disposal to tackle the monumental task of guiding a small hospital through big issues? Professional education on the health care issues that hospitals face is essential for rural trustees, as Karash makes clear in the cover story.  To that end, there is the Health Forum Rural Health Care Leadership Conference (shameless plug) and the AHA’s Center for Healthcare Governance. Even if you can’t attend the Rural Health Care Leadership Conference in February, please be sure to check out my colleagues’ coverage early next month, including blogs and video interviews with people on-site. It will be interesting to hear what rural health care leaders are discussing — and what they think about the issues with which you yourself might be wrestling.

Being a trustee at a rural hospital may feel at times like being the Earl of Grantham (especially this season) — wondering about the future and what changes it will bring. Rural hospital board members may have a big job, but those who are willing to spend their precious free time to ensure that their neighbors have access to top-quality care are making an important contribution to their community’s well-being.