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We examine whether loss of emergency department services is associated with county-level mortality rates in rural areas over the period 2005-2018. We use a propensity-weighted difference-in-difference approach, comparing counties that lost emergency department services to counties that retained them during our period. In the full sample, we find no effects of emergency department closure on all-cause mortality; drug, alcohol, and suicide deaths; or AMI mortality. We find that closure is associated with increased drug-related deaths among white and younger-aged females, and in the Midwest and the West, as well as an increase in AMI mortality in the South and West