Every year I go to DC to advocate on behalf of rural Virginia inside rural America. We converge from all 50 states and a couple of charted territories, spending a day catching up on the annual stats in health and economics, then charging The Hill to talk to the reps and senators for our individual states.

I’ve done this about eight years now, and this year sucked. Most don’t, but this time around the mood in DC and the mood at the National Rural Health Association match each other: big smiles in front of shattered glass plates.

We’re in trouble, and we know it. Insurance premiums in rural places are 150-300 percent higher than in urban areas. Insurers are refusing to enter some rural markets as a second company because the competitiveness makes the money they’d earn so low, it’s not worth it to them. And the Affordable Care Act, the thing we were all told we had to champion as though our lives depended on it, is about to go bye-bye.

There were some very honest moments this time around. A Senator told this group of beleaguered altruists that everyone involved knew the ACA rolled out with “terrible flaws” but that this was “anathema” to say in DC. You could feel the room struggling not to cheer, because we’d defended that dog’s breakfast up one side and down the other, lacking a better alternative. Not that we want its repeal to be accomplished before a replacement is in effect. Baby, bathwater. Let’s not walk backwards just because we walked too far too fast the first time out of the gate.

But we’re also struggling with the exhaustion of the staffers on The Hill, those sweet little 20-somethings who are, in the words of one we talked to, “the interns on which the back of this government is balanced.” They are tired. They are exquisitely, mind-numblingly tired.

We were supposed to ask them not to repeal the ACA. We wound up asking what they were hearing about what could replace it. Their eyes just about rolled back in their heads. Some smiled, some growled, a few talked in such bland cliches (robust, rolling out new ideas, a healthy America is good for all of us) I started counting them. He got to 10 before he quit.

But there was also a little spark in each encounter this year. When we walked into the offices of our Congressmen and women, they almost to a human commented on the power of rural to change things. Some sighed, some celebrated, but nobody was discounting us as that voiceless group that doesn’t vote out there in the sticks.

My takeaway point from this year’s NRHA conference is in two parts: 1) We’re screwed. 2) We don’t have the luxury of despair. As one friend says, “no matter how far down you are in rural, you can always find a well and climb in.”

And as we have pointed out to one another, over and over again during this conference, rural power has never been stronger. We elected a president. We proved that the Electoral College is necessary as a protection for rural voices. We reminded people to listen to us. (You should see the parade of Senators eager to address this convention this year; some of them have no idea who we are and one spent ten minutes explaining Medicaid to a room full of rural health experts. Oops.)

So if we’re screwed, we will have to unscrew ourselves. We elected a president on the power of our beliefs and knowledge. Now we have to get our healthcare positioned to really look after us, the voices that didn’t used to get heard.

It’s a little convoluted, but it’s not all bad. People may be tired, but they’re listening.