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In this chapter, we review the evidence for rural-urban and spatial variation of three major sets of mental health disorders: schizophrenia and related psychotic disorders, common mental disorders including depression and anxiety, and suicide. For each, we review the recent literature which has addressed these issues and report the main strengths and limitations of the available evidence. The most consistent evidence for rural-urban gradients in mental health risk are found to exist for schizophrenia and suicide, with more mixed evidence in relation to common mental disorders. For schizophrenia and suicide, we go on to review the major hypotheses that have been put forward to account for rural-urban variation in risk.