CAMERON — Days after the two hospitals in Milam County abruptly shuttered in December, Renee Mueck started feeling stomach pain so sharp she couldn’t drive herself to the nearest hospital about 40 minutes away.

Mueck, 60, said her husband drove her to a hospital in Temple, but her appendix burst before emergency room doctors could operate on it.

“It’s been devastating to everybody because in an emergency now, you have to run to Temple or to Bryan-College Station,” Mueck said. “There’s not a local facility, and it makes it hard on everybody because you never know what you’re going to need emergent care for.”

The hospitals in Rockdale and Cameron, about a 1½-hour drive northeast of Austin, are among the latest hospitals to close in the state, which, because of its size and vast rural areas, leads the nation in rural hospital closures.

Since 2010, 17 of the nation’s 100-plus rural hospital closures — which include facilities that have stopped offering short-term, acute inpatient care — have occurred in Texas, with little sign that the number is leveling off. The hospital in Chillicothe, about 65 miles northwest of Wichita Falls, closed Monday, and the hospital in Hamlin, about 40 miles northwest of Abilene, is expected to close Thursday.

About 16 other rural hospitals in Texas are at risk of closing because of financial difficulties, according to University of North Carolina researchers.

There are about 160 hospitals in small towns across Texas.

Following trends seen across the nation, Texas’ rural hospitals struggle financially because of low Medicaid and Medicare payments from the state and federal governments and the fact that there aren’t enough patients walking through their doors. Not only are rural populations dwindling, but many small-town Texans prefer to drive 40 or 50 minutes to a hospital in a larger city, where they believe they will receive better care than in their own community. Those relying on the smaller local hospital tend to be sicker, older and less likely to be insured, meaning they’re more expensive for the hospital to treat.

Desperate to build revenue, some hospitals have turned to questionable practices, including billing for high volumes of lab tests in apparent violations of contract with insurers.

Research also has shown that states that haven’t expanded Medicaid have higher numbers of rural hospital closures. Advocacy groups, hospital operators and some local officials are convinced that if the state expanded Medicaid, something Texas’ Republican leaders have been loath to do, more rural residents would be insured, lifting some of the financial burden from hospitals, which lose millions of dollars each year in uncompensated care.

“I would say do it. Why wouldn’t you?” Milam County Judge Steve Young, a Republican, said about expanding Medicaid. “For the time being that we can get it, maybe we can have a hospital here.”