In this brief, we find that counties with a majority of non-Hispanic Black and American Indian/Alaskan Native residents had significantly higher premature death rates (defined as years of potential life lost before age 75 per 100,000 people) than counties with a majority of non-Hispanic White residents, regardless of rural-urban location. When comparing counties with similar racial and ethnic compositions, rural counties had higher rates of premature death than urban counties. Additionally, we found that the highest rates of premature death were observed in rural counties where a majority of residents were non-Hispanic Black or American Indian/Alaskan Native.