No previous studies compare the prevalence of physiological hearing loss among older adults by nonmetro/metro residence. Also, there is little information on their relative successes in accommodating hearing loss with a hearing aid. This study sought to bridge these gaps by analyzing the 8,222 respondents to Wave 1 (1993?1994) of the national Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey. Respondents were classified into 4 categories of hearing status: (1) physiologically normal hearing; and physiologically abnormal hearing with (2) full accommodation of lost hearing with a hearing aid, (3) partial accommodation, and (4) no hearing aid. A multinomial logistic regression was used to predict the odds of having any of the 3 statuses of physiologically abnormal hearing rather than normal hearing. Nonmetro residents had the same odds as metro residents of having no residual hearing loss when a hearing aid was worn (versus having physiologically normal hearing). But nonmetro residents had a much greater risk than their metro counterparts of having a hearing loss but no hearing aid or a residual hearing loss even when wearing an aid. The association of nonmetro residence with either of these latter hearing-loss statuses was greater than that of age, a more traditionally acknowledged hearing-risk factor. Future studies should add nonmetro residence to the list of risk factors for negative hearing outcomes, especially since the percentage of elderly nonmetro residents is expected to grow over the next 2 decades.