Transportation is a vital issue for access to health care, especially in rural areas where travel distances are great and access to alternative modes such as transit is less prevalent. This study estimates the impacts of transportation and geography on utilization of health care services for older adults in rural and small urban areas. Using data collected from a survey, a model was developed based on the Health Behavior Model that considered transportation and distance as factors that could enable or impede health care utilization. A random sample of individuals aged 60 or older living in the rural Upper Great Plains states of North Dakota, South Dakota, Montana, and Wyoming was surveyed by mail. With a response rate of 20%, responses were received from 543 individuals. An ordered probit model was used to estimate trip frequency, and a binary probit model was used to estimate the likelihood that an individual would miss or delay a health care trip. Distance and transportation variables were not found to significantly influence the total number of routine or chronic care trips made overall, while emergency care visits were impacted by transportation options. However, additional results showed that those who cannot drive make more trips if someone else in the household can drive; distance and access to transportation impact the likelihood that someone will miss or delay a trip; and difficulty reported in making trips is significantly affected by distance and transportation options. The greatest problems for people using public transportation for health care trips is inconvenient schedules, the need to match transit and medical schedules, and infrequent service.