OBJECTIVE: To explore differences in quality of life and health service use for older women living in urban, rural and remote areas of Australia. METHODS: 8387 women aged 70–75 years when enrolled in the Australian Longitudinal Study on Women's Health completed mailed surveys in 1996, 1999 and 2002. RESULTS: Women living in urban, rural and remote areas reported few differences in health and had similar changes in health-related quality of life (SF-36) over time. Most SF-36 subscale scores declined over time, with steeper drops between the ages of 73–78 years and 76–81 years. The use of health services, need for informal care and provision of care to others increased over time. Urban participants used more general practitioner, specialist and allied health services, whereas non-urban women used more community services and alternative health practitioners. CONCLUSION: Despite similar health problems, health service use differs significantly across urban, rural and remote areas of Australia.