Examined access to healthcare during pregnancy for mothers insured by Medicaid as well as the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals. In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites. The authors conclude that providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.