Purpose <p>US residents of rural counties have a higher cancer-associated mortality than their urban and suburban counterparts. The impact of rurality is under-studied in glioblastoma. The purpose of this study is to determine if there are differences in clinical presentation, treatment patterns and outcomes in patients with newly diagnosed glioblastoma from urban and rural counties presenting to a single tertiary medical center in Vermont.</p> Methods <p>In this IRB-approved retrospective cohort study, adult patients newly diagnosed with glioblastoma from 2017 to 2021 were consecutively reviewed. Urban vs. rural county of residence was determined by US Department of Agriculture Rural-Urban Continuum Codes (1–3 = urban; 4–9 = rural). Correlates were assessed using Chi-Square test on SPSS (<i>p</i>-value &lt; 0.05).</p> Results <p>119 patients, 51 urban and 68 rural, of similar age, KPS, gender, ethnicity, and sex treated with the University of Vermont Medical Center (UVMMC) were included in the analysis. Time between symptom onset and neurosurgery did not significantly differ (median 14 days for rural patients and 15 for urban patients). Percent receiving gross total resection was similar (45% rural vs. 47% urban). 81% of rural patients vs. 82% urban received radiation and 78% rural and 80% urban received adjuvant temozolomide. Median progression free survival was 6.4 months for rural patients vs. 4.3 months for urban (<i>p</i> &gt; 0.05), and overall survival was 11.6 vs. 8.3 months, respectively, (<i>p</i> &gt; 0.05).</p> Conclusion <p>Urban and rural patients with glioblastoma at UVMMC had similar presentation, treatment, and outcomes. We hypothesize that access to a tertiary hospital centrally located in a rural catchment area with access to multidisciplinary neuro-oncologic management may help mitigate the disparities rural patients face when accessing cancer care.</p>