Questions of access to hospital services figure centrally in rural-health policy debates, yet few analyses exist that measure the importance of changes in hospital access in rural areas of the US. Of the studies that measure changes in access to hospital services over time in the literature, none use economic theory as the framework for the analysis. This paper proposes an economic approach based upon revealed preferences to measuring access to hospital services and quantifies the value of changes in hospital access over the period 1980 to 1999 for residents in rural counties in the US. Welfare measures are constructed for the years 1980 and 1999 for rural residents in all the rural counties of the US. On average the lowest levels of hospital access are found in the counties of the West, while Eastern US counties have better access to hospitals in comparison. The changes in hospital-consumer welfare indicate that over the period 1980 to 1999, access to hospital services has declined for rural US residents.