In Neurology, Sergio Gonzales and colleagues, including Michael Mullen and Allison Willis, examine differences in tissue plasminogen activator (tPA) utilization between rural and urban stroke patients. As with many health services, disparities in care based on geographic location or income exist, and rural populations often have little access to medical care. The authors used ten years of hospital discharge data from the National Inpatient Sample and indicators of tPA utilization for acute strokes. They find that, of 914,500 cases, tPA use in urban hospitals was quadruple that of rural hospitals. Of the 33 states with this data, 15 reached at least 75% of the maximum rural-urban inequality from 2004 to 2010. Greater understanding of the effectors of tPA utilization is necessary to ensure that access to tPA treatment is equitable for all communities.