Rural-urban health disparities in life expectancy are large and increasing, with the rural-urban disparity stroke mortality serving as a potential contributor. Data from Vital Statistics (referenced through the CDC WONDER system) shows an unexplained temporal pattern in the rural-urban disparity in stroke-specific mortality, with the magnitude of the disparity increasing from 15% to 25% between 1999 and 2010, but subsequently decreasing to 8% by 2019. This recent decrease in the magnitude of the rural-urban disparity in stroke mortality appears to be driven by a previously unreported plateauing of stroke mortality in urban areas and a continued decline of stroke mortality in rural areas. There is also a need to better understand the contributors to the higher stroke mortality in rural areas; however, a general lack of temporal data implies that this can only be examined cross-sectionally. A higher stroke incidence in rural areas appears to be a contributor to the higher rural stroke mortality, and there is clear evidence of a higher prevalence of stroke risk factors in rural areas potentially contributing to this higher incidence. Conversely, studies of rural-urban disparities in stroke case fatality show smaller and inconsistent associations. To the extent that disparities in case fatality do exist, there are many studies showing rural-urban disparities in stroke care could be contributing. While these data offer insights to the overall rural-urban disparities in stroke mortality, additional data are needed to help understand temporal changes in the magnitude of the rural-urban stroke mortality disparity.