Background/aims: To examine potential geographic differences among individuals with traumatic brain injury (TBI) and spinal cord injury (SCI) in demographics, rehabilitation services/costs, and outcomes at one year follow-up. Methods: 152 participants with TBI from the Missouri Model Brain Injury System and 149 participants with SCI from the Missouri Model Spinal Cord Injury System were enrolled at initial acute or rehabilitation hospitalization and followed for one year. Measures included demographics, rehabilitative services/costs, functional independence measure, residency at discharge, and substance use. Findings: Few differences in demographics or rehabilitation services were found when comparing rural and urban groups, and there were no differences in one year outcomes measured. Conclusions: The results suggest that, contrary to expectations, individuals with severe disabilities in rural areas do not necessarily experience worse outcomes than those in urban areas, indicating potential improvements in access to services in rural areas.