Rural residents often travel farther to access medical care, especially obstetric care, and are more likely to be uninsured or underinsured than urban residents. Infant mortality and maternal morbidity and mortality are higher in rural versus urban settings. Also, access to obstetric care is declining in rural areas. Research on the relationship between transfer, delivery hospital location, and severe maternal morbidity and mortality (SMMM) for rural residents is needed. The focus of this analysis is on rural residents who give birth. We compare hospital transfer rates for rural and urban residents who gave birth, and we provide descriptive information about the relationship between transfer status and SMMM for rural residents in a national sample of births that occurred 2008-2014.