What does it take to keep a rural pharmacy open? In some cases, selling third-generation land

Karen Dove's hands shake when she starts talking about what it takes to keep a rural pharmacy open.

Each day, she orders drugs customers need at the Seeley Swan Pharmacy. She pays for the drugs before she gets reimbursed and before a customer uses insurance to compensate for what it doesn't pay. Dove doesn't get repaid the full cost of the drug, though, and has to choose an amount she's going to sell a drug on which she's willing to lose.

Dove spends money when she's buying drugs and loses it when she's selling them to customers.

"Most every pharmacy has done everything they can think of to st...