This report uses county-level immunization data generated by state public health agencies to explore the rural-urban variation in the delivery of childhood immunizations in the public sector. Public health department-documented immunization coverage rates for 1995 were obtained from 882 counties in 11 states east of the Mississippi River. To assess the possible association between public health department immunization coverage rates and county rurality, descriptive statistics were calculated. A multiple regression model then was estimated. In all states except West Virginia, nonmetropolitan counties averaged higher completion rates than metropolitan counties. Consistent with the descriptive statistics, in the regression analysis nonmetropolitan counties had average immunization rates 2.47 percentage points higher than metropolitan counties, even when controlling for county socioeconomic characteristics. For the 11 states in the analysis, rural children immunized in the public sector had higher completion rates compared with urban children. These data reflect the dependence of rural families on the public health system and the potential for successful health care delivery through public clinics. As new health care systems are brought into rural areas, the success of this existing avenue for care must not be overlooked.