Unmet need for dental care is the most prevalent unmet healthcare need among children with special healthcare needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special healthcare needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs. Rural CSHCN are more likely to forgo needed dental care than their urban counterparts. Results suggest that rural CSHCN have unmet needs for dental care due to both difficulty accessing care and because their parents do not recognize a need.