PROJECT SUMMARY This project examines the physical and mental health impacts of extreme environmental events on the elderly, with an emphasis on how these impacts vary across the rural-urban continuum. Extreme environmental events — such as floods, wildfires, and hurricanes — are increasing in frequency and severity (Hayhoe et al. 2018) and rural residents are especially vulnerable given their lower levels of health insurance coverage (Cohen et al. 2021) and lesser access to health care. Physician density is much lower in rural areas (Machado et al. 2021) and ongoing hospital closures mean longer transport times, including for emergency care (GAO 2021). In fact, rural dwellers are already subject to the “rural mortality penalty” in that they already have lower life expectancies compared to their urban counterparts (Miller and Vasan 2021). We combine data on physical and mental health from the National Health Interview Survey, historical weather data, FEMA disaster declarations, and background on the scale and scope extreme environmental events and then link these to indicators of ruralness based on the USDA’s rural-urban continuum. We emphasize the connections between extreme environmental events and health for the rural elderly by contrasting the association for this group with that for younger individuals and urban dwellers. Of additional interest is the potential for social support and connection to be protective. In urban areas, social isolation has been found to play a role in mortality in disasters such as the loss of elderly life in the Chicago heat wave of 1995 (Klinenberg 2015). However, rural areas are characterized by relatively stronger social bonds (Henning-Smith et al. 2019) and we therefore examine the possibility of such connections benefiting the rural elderly in times of disaster. In all, this project is the first of its kind and provides information important for the development of programs and policies to protect elderly health in the context of rising environmental extremes.