There are a number of disparities associated with rural life that limit access to medical and oral health care. Health-care utilization in general, and oral health-care utilization in particular, is influenced by social determinants, including individual behaviors, local culture, and customs; health literacy; general education; economics; availability of services; and metropolitan/urban/rural residence. The older adult population is not a homogenous group in terms of oral health. Rural residence of older adults has not been shown to have an effect on many clinical oral health indicators, except tooth loss. Poor oral health may have systemic health consequences in older adults. There are ways in which the dental health of older rural adults may be improved. Community water fluoridation has been very successful in reducing dental caries. There is a need to evaluate such programs and scale them to a sustainable level if they are successful.