adverse mental and physical health outcomes in caregivers of persons with dementia are well documented, particularly for spouse caregivers. however, geographical setting may affect the caregiving experience. the main objective of this study was to investigate potential differences between rural and urban spouse caregivers in the health impact of caregiving, as well as identifying correlates of health status, health behaviors, and sleep disruptions. a sample of 33 spouse caregivers for persons with dementia in northwestern ontario was recruited, including 26 from an urban setting (population 109,000), and 7 from rural settings (populations < 9,000). rural caregivers rated the amount of information about how to access support services significantly poorer than did urban caregivers (t(31) = 16.76, < .001). no other statistically significant differences were found across residential settings in terms of caregiver health or health behaviors. however, different correlates of health status and health behaviors emerged for the two settings. for rural caregivers, lower levels of physical health were associated with higher levels of depressive symptoms ( r(5) = -.938, p = .002), higher levels of role burden ( r(5) = -.938, p = .002), and poorer care recipient functioning in basic activities of daily living ( r(5) = .895,p = .007). these associations were not significant for urban caregivers. it was also hypothesized that healthy behaviors would be positively associated with health status, but this hypothesis was not supported. sleep disruptions and depressive symptoms were reported by both groups. results suggest that the impact of caregiving may be different for rural and urban spouse caregivers. more research is needed, with larger and more representative samples, to further investigate these potential rural-urban differences.