Nearly one in five rural counties experienced worsening premature death rates over the past decade. Rural counties have had higher premature death rates than urban counties for many years. Over the past decade, premature death rates in urban counties have improved. In 1997, the years of life lost per 100,000 people under age 75 and who are residents of large urban counties was about 8,000, and in rural counties about 8,500 years of life were lost. By 2013, the years of life lost in urban counties dropped to about 6,500, but it still remained above 8 . . .