Purpose <p>This study assessed urban–rural differences in patient engagement through access and use of digital health tools. Government policies have sought to encourage patient engagement by enabling access and use of digital health tools in the US. This is because patients with access to their health information tend to be better informed and more engaged in the management of their health and health care. Patient engagement has the potential improve quality of care and patient health outcomes as well as reduce costs. To what extent have current government policies improved digital patient engagement?</p> Methods <p>Data from the 2020 and 2022 iteration of the nationally representative annual Health Information National Trends Survey (HINTS) was used for this study. Bivariate analyses were used to examine urban–rural differences across study variables. Multiple logistic regressions were performed, controlling for demographic variables, access and use of digital health technology.</p> Results <p>While the rates of access and use of patient portals have increased overtime, statistically significant urban–rural differences were observed. Rural residents viewed their test results, downloaded their medical records, contacted their health providers and made appointments online at comparably lower rates than urban residents.</p> Conclusion <p>Urban–rural disparities in the digital patient engagement persists, highlighting the need for more equitable access.</p>