Why rural hospitals need to stop renting talent and start building it — and what that actually takes.
"A traveler is a renter, and we want homeowners." Mark Sharon, VP of People Operations at Baylor Scott & White Healthcare, said this on a recent industry panel about the true cost of healthcare staffing — and it landed with everyone on the call, but especially with the person from a 25-bed critical access hospital who asked the panel point-blank: does this "grow your own" idea even work at a hospital our size, hiring maybe two surgical techs a year?
The panel's answer was unanimous: size doesn't disqualify you. If anything, the model matters more in small, rural markets — because a rural hospital can't out-recruit its way out of a shortage the way a large system might try to. There's no bigger pool to dip into. There's only the workforce you build.
For rural hospitals, the renter-versus-owner question isn't philosophical. It's a line item.
What renting actually costs a rural hospital
Nationally, hospitals spent an estimated $51.1 billion on contract and agency staff in 2023, part of a total labor bill that's climbed past $839 billion — nearly 60% of the average hospital's entire budget (American Hospital Association, 2024 Costs of Caring). The AHA's own reporting is explicit that this hits rural and smaller hospitals hardest, because the local labor pool is thinner to begin with. A large system can absorb a bad staffing year. A rural hospital usually can't.
One rural hospital CEO on the same panel described watching costs that were "a couple hundred thousand dollars" before the pandemic balloon into "a couple million dollars" after it — and he was quick to note it wasn't isolated to nursing; travel staffing and medical imaging carried similar premiums. The same dynamic holds wherever the local labor pool is thin: agencies fill surgical tech, sterile processing, and other allied health gaps too, usually at a comparable markup.
Why the bill never actually goes down
Here's the structural problem: a traveler has no reason to build the institutional knowledge that would let a hospital stop paying premium rates. They rotate through, and the hospital re-pays the recruiting markup every contract cycle. For a large system, that's a rounding error. For a rural hospital, it's often the single biggest controllable line item on the budget — controllable, because it's the direct result of a staffing model, not an unavoidable cost of doing business.
What owning looks like instead
The alternative is growing your own — a structured, employer-sponsored path where someone earns and learns their way into a role like surgical technologist or sterile processing technician, instead of a hospital importing that person through an agency contract. When it's built through a Department of Labor–recognized structure, it's called a registered apprenticeship: paid work from day one, paired with real instruction toward a credential.
One health system on the panel described using exactly this approach when a role it needed less of elsewhere started shrinking — rather than posting an external requisition, they moved existing staff into surgical tech positions through an apprenticeship pathway. An internal transition became a pipeline instead of a layoff.
What it actually takes to build this
Standing up a registered apprenticeship alone is where most rural hospitals stall out — not because the idea is wrong, but because it requires four things most hospitals aren't set up to assemble on their own:
- A sponsor to formally hold the apprenticeship program.
- Braided funding — combining sources like CTE/Perkins, WIOA, Workforce Pell, SAEF, and rural-specific streams like RHTP, rather than relying on one grant to cover the whole cost.
- A curriculum partner to actually deliver the instruction — a rural hospital shouldn't have to build a training program from scratch to run one.
- Compliance and reporting, since registered programs come with real documentation requirements. In Craft Connect, we give the hospital's own coordinators, preceptors, and apprentices a system to log hours and progress themselves, so reporting doesn't become one more unfilled job.
At Craft, we assemble these four pieces for rural allied health roles — so a rural hospital gets the infrastructure without building it alone.
Does it actually pencil out
The data says yes. Registered apprenticeship completers show a 91% employment retention rate (U.S. Department of Labor) — a direct answer to "we'll train them and they'll just leave." A frequently cited federal cost-benefit estimate put the return around $27 in tax revenue and $35+ in total benefit for every $1 invested in apprenticeship (Mathematica/DOL, 2012) — dated, but directionally consistent with a newer DOL-commissioned evaluation now testing the same question specifically for healthcare.
And the cost of not doing this is real: one health-system presentation on perioperative staffing found first-year surgical tech turnover at 42.9%, climbing to 55.6% by just 90 days — against a typical 9-month orientation runway. That means many new hires leave before they're even fully trained, and the hospital pays the agency premium again to replace them. Set that against a 91% retention rate for apprenticeship completers, and the math is straightforward: for most rural hospitals, the contract-labor bill is largely a retention problem wearing a staffing-shortage costume.
Your next step
You don't have to assemble a sponsor, funding, a curriculum partner, and a reporting system from scratch — that infrastructure already exists. If you're a rural hospital ready to stop renting talent for surgical tech, sterile processing tech, or EKG tech roles, contact us to see what building your own actually looks like.
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