CLAXTON — The reasons given for 49-bed Evans Memorial Hospital in Claxton entering a “strategic partnership” with much larger Memorial Health in Savannah mirror the struggles of small, rural hospitals nationally.“We knew that we were going to have to align ourselves with someone to help us make sure that we had a good niche in the market and who could help us try to strategize and figure out what to do when the rules come out,” said Evans Memorial Hospital CEO Martha Tatum.The rules, yet unknown, are those that will affect hospitals under the Affordable Care Act, popularly known as Obamacare, as it is implemented. The new national health insurance law adds to uncertainty created by changes in Medicare and Medicaid, Tatum said in an interview. Dealing with this uncertainty, reducing costs through Memorial Health’s purchasing power, and getting help from the Savannah teaching hospital in recruiting physicians were reasons officials noted for the agreement announced Thursday.Similarly, difficulty recruiting doctors to rural areas and limited resources for adjusting to the Affordable Care Act, as well as high costs relative to revenue, were identified in an April 2011 American Hospital Association report on challenges facing rural hospitals.“Some rural hospitals have formed strategic alliances with metropolitan or other rural hospitals across a region,” said the report, online at www.aha.org/research/policy/2011.shtml.In 2013, various kinds of affiliations are becoming more common for Georgia’s small rural hospitals, Georgia Hospital Association spokesman Kevin Bloye said.For some small rural hospitals, teaming up becomes a matter of survival.