Findings from this study indicate that rural mothers are significantly more likely than their urban counterparts to be smokers, smoke frequently, and smoke heavily, even after adjusting for factors known to increase smoking risk. The authors suggest that policymakers consider methods for extending insurance coverage for smoking cessation interventions through the Affordable Care Act and Medicaid. Additionally, anti-smoking initiatives at the local, state, and national levels could play an important role in decreasing rural-urban disparities in smoking-related morbidity and mortality.