ST. PAUL — The closure of dozens of nursing homes in rural Minnesota over the past two decades has put pressure on the small communities that rely on them for care, income and revenue.

Care Providers of Minnesota, a nonprofit that advocates for people who work in the industry, said that of the 41 nursing homes that have closed in the state since 2007, 31 have been in rural towns.

The closures are happening because nursing homes are costly to run, highly regulated and qualified staff is hard to find and retain, Minnesota Public Radio reported .

In the small northwestern Minnesota city of Twin Valley, Mayor Ben Fall said the closure of the Twin Valley Living Center in November wasn’t just hard on the home’s residents and their families, who scrambled to find alternative accommodations. It was hard on the whole community, he said. The home employed 58 people in the city of 783.

“Our main street is really struggling right now,” Fall said. “The businesses that are there are doing a great job, but there’s not a lot of businesses there anymore. We’ve lost a cafe. Employees that are there now, where are they going to end up?”

Nicole Kruger, who owns the Twin Valley Pharmacy, said she lost about 20 percent of her business when the home closed.

State Sen. Kent Eken, a fifth-generation resident of Twin Valley, said he observed the nursing home’s struggles firsthand when his father entered the facility. He worked with the Legislature for years to improve Medicaid payments to rural facilities, resulting in improved rates that took effect in 2016.

“I was always concerned that we would end up seeing closures if something wasn’t done quickly or soon,” he said. “But it wasn’t soon enough for many, and that included my hometown.”

Karen Olson, whose mother passed away not long after being moved from the Twin Valley facility, said the care and staff at the new nursing home was on par with Twin Valley, but that it was farther away.

She said she misses the community at the home in her town, which felt like extended family.

“It’s tough and it’s tough to drive by there every day and see the building empty,” she said.