Rural Americans have historically faced significant challenges in accessing healthcare and preventive healthcare services, including ambulatory care, dental care, emergency services, and pharmaceutical services. Rural Americans are more likely to die from conditions generally considered self-manageable or preventable. This study examines rural versus urban differences in how the U.S. is meeting the Healthy People 2020 mortality objectives for many of the leading causes of death. Our analyses use national vital statistics mortality data available through the Centers for Disease Control and Prevention's Wonder website. Overall, our findings indicate rural America is lagging behind urban America in achieving these objectives. Furthermore, key findings indicate men have been less likely than women to achieve these objectives, the rural South has seen less progress than other regions toward many of the objectives, and suicide mortality has increased across all levels of rurality.