Do adults in rural locations report lower dental care utilization or higher prevalence of dental disease or both compared with their urban counterparts? This analysis of data from the Behavioral Risk Factor Surveillance System (BRFSS) shows that residents of non-metropolitan counties were significantly less likely than residents of metropolitan counties to report having a dental visit or teeth cleaning in the past year and significantly more likely to report undergoing tooth extraction. These findings persisted even when controlling for demographic factors, income, insurance and health and smoking status. Policies aimed at increasing the supply of generalist dentists who will choose to work in rural areas may reduce these substantial rural/urban disparities in access to oral healthcare and dental outcomes.