Children living in rural areas have distinct characteristics of traumatic injury compared to urban children, and unique challenges to their care. Deciding on the best management of these injured children requires determination of the most appropriate setting and personnel to care for pediatric patients with traumatic injuries. Answering this question is difficult as there is a paucity of literature looking specifically at the outcomes of traumatically injured rural children by treating physician specialty or even by trauma center designation. Overall, the mortality rate for injured children in rural areas seems to be higher compared to comparably injured urban children. Pediatric trauma centers, compared to non-trauma centers or adult trauma centers, seem to have the best survival outcomes for these rural patients, though these results may be confounded. The higher rate of mortality is likely due to logistic difficulty in accessing pediatric trauma centers, and pediatric specialists. However, for rural children over the age of 12, some studies suggest care at a high-level adult trauma center has equivalent mortality outcomes to pediatric trauma centers. The data thus suggest that ideally, younger rural pediatric patients should be cared for at a pediatric trauma center, and older children can receive equivalently good care at an adult trauma center. But prompt care at a dedicated trauma center is simply impossible for many children in rural America, where trauma centers and the means to rapidly reach one are scarce. To ensure that injured children in rural areas receive adequate trauma care, before or in lieu of transport to a larger center, rural hospitals must maintain basic preparedness for pediatric care and the capacity to operate on critically ill children.