Rural patients are characterized by high behavioral health needs and high barriers to service utilization. One promising approach to addressing health inequities in the rural population is to integrate behavioral health services into rural primary care clinics. This study compared behavioral health needs, service utilization, and functional improvement of adult patients receiving behavioral health services at rural (n= 116) and urban (n= 77) primary care clinics, both part of a large federally qualified health center. Patient demographic information, medical and behavioral health diagnoses, and service use were gathered from electronic medical records. Measures of psychological stressors and psychiatric symptoms were assessed at behavioral health appointments. Contrary to our hypotheses, rural patients did not evince higher medical or behavioral health symptoms than did urban patients. A larger proportion of patients from the rural clinic utilized behavioral health services and were more likely to reside in cities that were not in the same location as the clinic as compared to urban patients. Rural and urban patients attended a similar number of behavioral health sessions. A mixed analysis of variance revealed patients at both rural and urban clinics significantly improved in global functioning following an episode of behavioral health care; there was no significant effect of clinic location on observed improvements in functioning seen in patients. Integrated behavioral health care is a promising approach to increase access to behavioral health services for rural residents.(PsycInfo Database Record (c) 2021 APA, all rights reserved)