We studied rural-urban differences in medical spending trends over eleven years for VA as well as non-VA care received by male veterans who used any VA services, and compared those trends to trends for other healthcare-using men. Using inflation-adjusted annual medical expenditures for non-veterans, VA users, and other veterans who participated in Medical Expenditure Panel Surveys from 1996 through 2006, we examined trends in spending on inpatient, hospital-based outpatient, office-based, pharmacy, and other care, by major payers (self/family, private insurance, Medicare, other sources, and VA), to assess changes in expenditures for the care of rural veterans, younger or older than 65 years, compared with other healthcare users. For all groups, spending for pharmacy and office-based care increased fasterthan inflation, while other care categories did not change consistently. VA spending also increased for these but not other services, and it grew sharply for working-age rural veterans, possibly reflecting improved access through community-based care