Background. People in rural (vs. urban) places have worse health outcomes. We examined the role of healthy food availability and consumption in this health disparity. Method. We surveyed rural (n=313) and urban (n=458) Oregon residents online, and analyzed data from rural (n=1 235) and urban (n=13 912) respondents in the U.S. nationally representative Health Information National Trends Survey (HINTS). We followed up pre-registered simple mediation models with post-hoc multi-mediator models combining the datasets. Results. As pre-registered, healthy food availability mediated the rurality-BMI relationship in the Oregon survey (8% proportion mediated, 95% CI [2%, 48%], p<0.05). In HINTS, we found fruit and vegetable consumption mediated the relationships between rurality and self-rated health (ACME=0.03 [0.02, 0.04], p<0.001), high blood pressure (ACME=0.004 [0.002, 0.01], p<0.001), and metabolic health (0.008, [0.004, 0.01], p<0.001). In a hybrid model, the effect of rurality on BMI (ACME=0.0119 [0.0043, 0.0227], p=0.0292) and health outcomes (ACME=0.0029 [0.0011, 0.0054], p=0.0083) was mediated by a combination of income and perceived fruit and vegetable availability and consumption. Conclusion. Nationwide data demonstrate rural-urban disparities in cardiometabolic health, self-rated health, and BMI are mediated by a series of two factors: income, and fruit and vegetable consumption. Oregon data suggests those factors in turn are mediated by a third factor, fruit and vegetable availability, and overall, the three factors together appear to mediate the rural-urban disparities. To address rural-urban health disparities, individual health behaviors, household income, and community healthy food availability should be targeted together.