Objective: Despite studies suggesting that there is a higher prevalence of overweight or obese children in rural areas in the U.S., there are no national studies comparing the prevalence levels of overweight or obese rural to metropolitan children. The objective of this research was to examine the hypothesis that living in a rural area is a risk factor for children being overweight or obese. Research Methods and Procedures:Using the National Survey of Children's Heath, the prevalence of overweight and/or obese rural children was compared with that of children in metropolitan settings. Multivariate analyses were performed on the data to detect if differences varied by health services use factors or demographic factors, such as household income, gender, and race. Results: Multivariate analysis revealed that overweight or obese children Ն5 years of age were more likely to live in rural rather than metropolitan areas (odds ratio ϭ 1.252; 95% confidence interval, 1.248, 1.256). Rural overweight U.S. children Ն5 years of age of age were more likely than their metropolitan counterparts to: be white, live in households Յ200% of the federal poverty level, have no health insurance, have not received preventive health care in the past 12 months, be female, use a computer for non-school work Ͼ3 hours a day, and watch television for Ͼ3 hours a day. In addition, they were more likely to have comorbidities. Discussion: Living in rural areas is a risk factor for children being overweight or obese.