Previous studies have suggested that men and women in rural areas are less likely than those in urban areas to receive routine cancer screening. Methods: We examined the colorectal cancer screening practices of men (n = 23,565) and women (n = 37,847) aged >50 years living in rural areas and other areas of the United States using data from the 1999 Behavioral Risk Factor Surveillance System (BRFSS). Geographic areas of residence were classified as rural areas and small towns, suburban areas and small metropolitan areas, and larger metropolitan areas using US Department of Agriculture (USDA) urban/rural continuum codes. The estimated median response rate across states was 55.2%. Approximately 16.2% (95% confidence interval [CI] = 15.3% to 17.2%) of persons aged >50 years who resided in rural areas had received a fecal occult blood test in the past year, compared with 22.0% of those living in the larger metropolitan areas (95% CI = 21.4% to 22.7%). About 28.2% (95% CI = 27.1% to 29.4%) of those who resided in rural areas had received a sigmoidoscopy or colonoscopy in the past 5 years, compared with 35.2% of those in the larger metropolitan areas (95% CI = 34.5% to 36.0%). These results underscore the need for continued efforts to increase colorectal cancer screening in the United States. Special efforts may be required to increase screening in rural areas.