Purpose: The purpose of this study was to compare the characteristics of rural versus urban caregiving grandmothers along with their physical and mental health status. Methods: A secondary analysis of data produced from the first wave of a longitudinal study of 485 Ohio grandmothers was conducted. Health status was measured using the SF-36 Health Survey and the 20-item CES-D depression scale. Rural-urban classification was made using Rural Urban Commuting Area (RUCA) codes based on resident ZIP codes, identifying 97 rural and 388 urban grandmothers in the sample. Findings: The rural and urban grandmothers were similar in age, educational level and employment status; however, 90% of the rural grandmothers compared with 60% of the urban grandmothers were white. Rural grandmothers were most likely to have traditional nonresidential relationships with their grandchildren. Approximately 38% of both the rural and urban grandmothers served as primary caregivers for their grandchildren, but a lower percentage of rural grandmothers lived in multigenerational homes. There was no significant difference between the rural and urban grandmothers in relation to physical or mental health. Among rural grandmothers, primary caregivers had significantly lower levels of mental health compared with the other caregiver groups. Conclusions: These findings suggest that rural and urban grandmothers have similar levels of physical and mental health, despite differences in demographics and caregiving arrangements. Health promotion efforts with rural caregiving grandparents are indicated, addressing both mental and physical health.