ST. PAUL (AP) -- Dozens of nursing homes have closed in rural Minnesota in the past two decades, putting pressure on the small communities that rely on them for care, income and revenue.

Nursing homes are costly to run, highly regulated and qualified staff is hard to find and retain.

Twin Valley Mayor Ben Fall says the closure of the Twin Valley Living Center in November wasn't just hard on residents and their families who scrambled to find alternative accommodations, it was hard on the whole city. The home employed 58 people in a city with a population of 783.

Fall says the closure has had a knock-on effect on main street. A cafe closed. And Nicole Kruger, who owns the Twin Valley Pharmacy, says she lost about 20 percent of her business when the home closed.