The purpose of this study is to examine whether or not there is poorer geographic access to health care in more rural counties. Possible inequalities in health care access and utilization were examined for populations living in twelve counties in the mountain region of North Carolina with different degrees of rurality, defined by Beale Code groupings based on urban population size and adjacency to a metro area. Several measures of availability, geographic accessibility, and utilization of practitioners were employed in the study. Data were derived from the U.S. Census, public and proprietary physician databases, and a household survey of 1,059 households. Overall, with some small exceptions, there was little difference in access by degree of rurality at the Beale Code level of analysis. Some types of access were better for more rural populations and some were better for less rural populations. Health Professional Shortage Area (HPSA) guidelines for population to primary care physician ratios, and Health and Services Administration (Bureau of Health Professions) guidelines for travel time and distances were met for the majority of the population. The related issues of how to measure rurality and appropriate geographic scales of analysis are discussed.