This policy brief examines the health of rural elders and, by contrast, their urban counterparts, and finds that both groups are more likely to be unhealthy than suburban older adults. Specifically, the authors find that rural older adults have higher rates of overweight/obesity, physical inactivity and food insecurity than older adults living in suburban areas. They are also more at risk of heart disease, diabetes and repeated falls. Yet rural elders, because of their geographical isolation and lack of proximity to health care providers, experience unique environmental and other risk factors that require context-specific solutions to these health issues. The authors argue that in both policies and programs that impact health, policymakers need to take into account the distinctive environmental and social context of older adults living in California’s countryside.