"We want to maintain our culture and our ability to make our decisions ourselves about what we want for our community and our patients. That is the key thing that we do not want to give up," said Tim Rice, president of Lakewood Health System in Staples. Rice's determination stands out in a climate where more rural hospitals are joining larger health system just to survive. Supported by its four small-town clinics, Lakewood is highly regarded. It ranks near the top when compared to other Minnesota hospitals in patient surveys. These days, it's hard for either hospitals or doctors to stand alone. The rural healthcare equation is changing.