This study examined differences in health care access and utilization in urban; rural, adjacent; and rural, nonadjacent areas. Data came from the National Survey of American Families, a survey of children and adults under age 65 in over 44,000 households which provides representative information on the nonelderly population for 13 states and the nation overall. This study used data on Alabama, Colorado, Michigan, Minnesota, Mississippi, Texas, Washington, and Wisconsin. Data show that national patterns may not necessarily be reflected in all states, and some states may have problem areas not apparent in national statistics. According to the results, rural areas are poorer than urban ones, and the more isolated the rural area, the greater the degree of poverty. Results are presented for insurance coverage, health status, health care visits, lack of confidence in getting needed care, and state profiles. Overall, the study confirmed many of the rural health care problems that have been identified elsewhere (e.g., low incomes, inadequate insurance coverage, health problems, and lower rates of service use). States varied significantly in the severity of the problems. (SM)