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An estimated 17 million people could lose their health insurance , putting financial strain on hospitals.

Rural hospitals across the U.S. say they’re being forced to consider tough choices — like cutting services for children or cancer patients — after Donald Trump signed into law a sprawling domestic policy bill that includes sweeping cuts to not only Medicaid but the Affordable Care Act, as well.

Benjamin Anderson, CEO of Hutchinson Regional Healthcare System, oversees a 180-bed hospital that serves as the only hospital for many residents in rural South Central Kansas. He’s evaluating how the hospital and its broader health system will be able to afford to keep offering all of its services, which includes hospice and home care, inpatient mental health treatment, and a cardiology program.

Services that aren’t traditionally profitable — such as women’s health and pediatric care — will be the hardest to sustain, Anderson said. He added the system is trying to see which programs can be saved.