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The turn of the 21st century has been a challenging period for American mortality. Life expectancy in the United States ranked 30th in the world in 2010 and is much lower than in other high-income countries. Since 2010, a stagnation in U.S. life expectancy has caused the U.S. to fall even further behind its peer countries; U.S. life expectancy increased only by 0.14 years between 2010 and 2015, the smallest 5-year increase on record since 1970. At the same time, recent decades have been characterized by large and growing socioeconomic and geographic inequalities in health and mortality within the United States. Recent trends show remarkable improvements in life expectancy in large metropolitan areas. Sizeable differences in life expectancy exist across regions, but large central metros have performed uniformly well since 1990 across all regions. In contrast, non-metro areas have experienced much smaller improvements or even stagnation in life expectancy over the past 25 years. Most prior studies focused on geographic differences in life expectancy across counties, states, or regions, which has obscured a central dimension driving these geographic differences – urbanicity. The degree of urbanicity of one’s place of residence is itself an important stratifying dimension of socioeconomic status (SES) and access to health care services.