How are rural areas faring with the Affordable Care Act? Has the law fostered competition among plans or have one or two insurers dominated? This Data Brief examines 2014 premiums and finds that residents of rural counties, as a whole, did not face higher premiums than residents of urban counties. However, states with largely rural populations do face fewer choices and higher premiums. These are the states to watch as new issuers enter the marketplaces and 2015 premiums are filed.