Motor vehicle crashes are the leading cause of death for Alabama children. This fact persists despite a child restraint law and an amendment designed to prevent such deaths in preschoolers. This study compared cumulative motor vehicle-passenger death rates by county and by urban and rural residence. Rural children had twice the rate of death of urban children. Additionally, these death rates demonstrated a sharp negative gradient when residence areas were ordered by increasing population densities (rural agricultural, rural manufacturing, suburban, and urban, respectively). Because child passenger death rates are significantly higher among rural children, future research should focus on hazards associated with the rural environment. A list of key study elements is provided. © Lippincott-Raven Publishers.