In rural areas of the country, where hospitals often have enough beds for just a few dozen patients, 15 facilities have shuttered this year as of Oct. 20, including 11 since March, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. There may be as many as 18 such closures in 2020, topping last year’s record high. The hospitals in the worst financial shape generally have one thing in common: they serve the country’s most vulnerable people, who rely on Medicare and Medicaid or who are poor and uninsured.