© 2019 The Author(s). Published by Wolters Kluwer Health, Inc. Recent reports have documented rising rates of CEO turnover. This phenomenon can have negative implications for hospitals and their surrounding communities, particularly in under-resourced rural communities. Ostensibly, components of the Affordable Care Act have addressed some of these resource challenges and may have helped to slow the CEO turnover trend in rural areas. We examined this possibility with a longitudinal analysis of U.S. acute care hospitals over an extended period (2006-2015) to examine whether patterns of CEO change differed for hospitals in different types of geographic areas (e.g., rural vs. urban). The rates revealed by our analysis seem to be problematic, with nearly one-quarter of all U.S. hospitals experiencing a change in CEO every 3 to 4 years, on average. Moreover, while the likelihood of a CEO change increased significantly over time for hospitals in nearly all types of geographic areas, it was nearly twice as large for frontier hospitals in areas with fewer than 2,500 residents compared to urban and rural hospitals. Our study suggests that the stability of hospital CEO leadership has declined over the past decade, particularly for vulnerable frontier hospitals, and highlights the need for recruitment and retention strategies to address this challenge.