The current study examines whether chemical releases from facilities monitored through the Toxics Release Inventory (TRI) program were associated with population mortality rates and birth outcomes for both rural and urban populations. We also examined whether rural and urban areas characterized by poor socioeconomic status or higher percentages of racial minorities had greater TRI releases. Health outcomes included age-adjusted CDC mortality rates for cancer, respiratory, cardiovascular, and total causes, and NCHS birth outcomes including low birth weight, preterm births and birth defects. Rural counties are defined as non-metropolitan based on rural-urban continuum codes. The results show significantly higher adjusted total mortality rates associated with greater air and water releases in both rural and urban counties, after controlling for the effects of other risk variables. Effects were found in rural areas for total, cardiovascular, and (marginally) cancer mortality outcomes. We found that counties with higher percentages of African American populations had more non-zero releases, but did not find this for populations characterized by greater Native American populations, lower income levels or higher poverty. We did not find consistent evidence for higher TRI releases being related to poorer birth outcomes. Suggestions for reducing emissions, further research to understand human health impacts, and improving rural healthcare are presented.