Multiple sclerosis (MS) is the most common neurologic disease that disables younger adults, affecting as many as 350,000 Americans. Purpose: The objectives of this study are to develop profiles of nursing home residents with MS from rural areas and compare them to residents with MS who lived in urban areas, suburban areas, and large towns. Methods: We analyzed all admission assessments for residents with MS (13,357 assessments) in the Minimum Data Set between June 23, 1998, and December 31, 2000, that also had the resident?s ZIP code of primary residence before admission. Findings: Urban and rural comparisons of residents with MS demonstrate a range of significant demographic differences. Significantly greater proportions of MS residents from rural areas exhibited a sense of initiative or involvement in activities of the nursing facility compared with residents with MS from urban and suburban areas. The differences in the utilization of physical and occupational therapies were striking, with MS residents from rural areas averaging significantly fewer minutes of these therapies. We also found that MS residents from rural areas averaged fewer minutes of psychological therapy in the nursing facility and also were less likely to have seen a licensed mental health specialist than MS residents from urban areas. Conclusions: Nursing home residents with MS from rural areas receive fewer therapies and less mental health care than residents with MS from other areas.