Objective: To determine whether health literacy is lower in rural populations. Method: We analyzed health, prose, document, and quantitative literacy from the National Assessment of Adult Literacy study. Metropolitan Statistical Area designated participants as rural or urban. Results: Rural populations had lower literacy levels for all literacy types (P less than 0.001 for each). After adjusting for known confounders, there was no longer a difference in health or prose literacy (P greater than 0.05). However, rural populations had higher document (P = 0.04) and quantitative (P = 0.01) literacy. Conclusion: Health literacy is lower in the rural population although this difference is explained by known confounders.