Rural/urban split. Many cities instead contend with local politicians who want to put a feather in their cap by giving concessions to developers to build new, expensive facilities (instead of, say, driving that money into actual healthcare or the rehab of existing facilities). What will happen is that the taxpayers will give millions to have a greenfield facility built, and around that time, the older local facility (likely to be servicing poorer residents or those without transportation access) will get shut down. Expanding building doesn't fix this dynamic, it makes it worse.