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Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. The results of this research indicate that differences in patient mix and the type of healthcare utilized exists, suggesting that rural patients may have special needs as they tend to be older and use accompaniment than those needing transportation for shorter urban trips. Understanding the differences in NEMT use by middle and older age by rurality can assist in planning for mobility and healthcare delivery over the life course and by context. For example, reduced support for preventive care in rural areas can end up being costly long-term when accounting for the transportation and treatment of avoidable chronic conditions.