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This qualitative research focused on the emergency preparedness (EP) rule implementation in rural hospitals in the Pacific Northwest. A new law has been implemented that requires hospitals to comply with Medicaid and Medicare law. Learning about the implementation and preparedness process could help rural regions in the Pacific Northwest better prepare for emergencies and comply with the law. The purpose of the study was to gain increased understanding of how the new EP rule of 2016 impacts rural hospitals' preparedness in the Pacific Northwest. The theoretical framework was complexity theory. This study focused on the lived experience of emergency managers who have been working on the implementation of the new EP rule in rural hospitals in the Pacific Northwest. Using a phenomenological approach, 8 in-depth phone and face - to - face interviews were conducted. Selection criteria included working as emergency preparedness managers in rural hospitals in the Pacific Northwest. The verbatim transcripts of interviews were analyzed by first cycle analysis, used concept and descriptive coding to find common themes. The findings of the study included that small rural hospitals working on EP need more support and help that include financial needs, resources, staff preparedness improved communication and more exercises local communities including every individual living in the community are also responsible for their own preparedness. This inquiry could help understand the effects of the new EP rule for rural hospitals; it could identify gaps in research that could support rural hospitals and surrounding communities; it could affect positive social change by applying the research evidence to additional health care settings.