Cromwell, a veteran character actor probably best known as the farmer in Babe and Zefrem Cochrane in Star Trek: First Contact, does marvelous work here. In an American movie with a big enough name director, it's the sort of acting that gets an Oscar nomination. Bujold is also excellent, underplaying her descent into greater and greater silence and confusion. In her case, she's not showy enough for an Oscar nomination.
The movie could have devoted a few more minutes to the specifics of the bureaucratic hoops Cromwell keeps getting forced to jump through -- this is a relatively rare case in which exposition would help the dramatic elements. Nonetheless, the film is beautifully shot in both its long looks at landscapes and beaches and the passing of the seasons, and in recurring extreme close-ups of things one doesn't generally see in Hollywood movies -- which is to say, old faces and old bodies.
The supporting cast, mostly unknown with the exception of Campbell Scott, is excellent, low-key, and real-looking. One doesn't realize how unreal the casts of even the most serious of American dramas look until one sees people who look real, whether in independent movies or even in Hollywood movies made prior to the 1990's, when our genetically engineered overlords seized control of most mass-market movies and TV shows. Highly recommended.