Nine out of 16 rural hospitals in New Hampshire have closed their labor and delivery (L&D) units since 2000, largely because of financial pressures and quality concerns associated with declining birth rates. To better understand the consequences of these closures for women in rural New Hampshire, we explored how the driving time to open units has changed and examined the association between proximity to an open unit and women’s health and socioeconomic characteristics. We find that the median driving time to the nearest L&D unit increased from 18 to 39 minutes after closures across eight hospitals, and that the share of pregnant women who lived more than 30 minutes from an open L&D unit increased from 20.2 percent in 2000 to 27.3 percent in 2018. Reduced proximity to an open unit was associated with an increased probability of attending fewer prenatal care visits than is recommended and giving birth en route to the hospital or having an unplanned home birth. Moreover, those living farthest from open units faced significant socioeconomic disadvantages, making them even less able to bear the time and financial costs of the increased travel. This study provides important information for providers and policymakers as they seek to ensure equitable access to safe and secure pregnancy and delivery services for women in rural communities.