This study employs a longitudinal design to examine rural-urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba ( n = 855) were collected in 1991/1992. Place of residence was categorized as urban/small-town zone or predominantly rural area . A 5-year follow-up determined subsequent home care use. Urban residents were more likely to receive home care than those in small-town zones or predominantly rural areas. Characteristics associated with use differed according to place of residence, with the exception of baseline physical functioning and changes in physical functioning that consistently emerged as significant. Directions for future research are discussed.