**NOT PEER REVIEWED**
In the May publication of Pediatrics there was an article entitled “Characteristics of Rural Children Admitted to Pediatric Hospitals” which I read as I am also interested in rural health care. One of the most interesting findings in their study of admissions to freestanding children’s hospitals was that hospitalized rural children had higher rates of medical complexity when compared to hospitalized nonrural children. The authors postulate this difference may due to children with medical complexity preferentially seeking treatment at a freestanding children’s hospitals over a local hospital and not necessarily that rural areas have higher rates of children with medical complexity. Prior studies have shown that individuals with medical complexity often travel long distances for hospital care and personally I have seen this when caring for my patients with complexity. Many children’s hospitals have travel or outreach outpatient clinics for their specialties to reach rural patients and I agree with the authors that we need to work on the availability of high-quality inpatient care to our children with medical complexity.