Background: We determined differences in knowledge of concussion and reporting behaviors of high school athletes attending urban and suburban high schools, and whether a relationship exists between underreporting and access to an athletic trainer in urban schools. Methods: High school athletes (N = 715) from 14 high schools completed a validated knowledge of concussion survey consisting of 83 questions. The independent variable was school type (urban/suburban). We examined the proportion of athletes who correctly identified signs and symptoms of concussion, knowledge of concussion and reasons why high school athletes would not disclose a potential concussive injury across school classification. Data were analyzed using descriptive, non-parametric, and inferential statistics. Results: Athletes attending urban schools have less concussion knowledge than athletes attending suburban schools (p < 0.01). Athletes attending urban schools without an athletic trainer have less knowledge than urban athletes at schools with an athletic trainer (p < 0.01) There was no significant relationship between reporting percentage and school type (p = 0.73); however, significant relationships exist between AT access at urban schools and 10 reasons for not reporting. Conclusion: Concussion education efforts cannot be homogeneous in all communities. Education interventions must reflect the needs of each community.