<p>Air pollution is often seen as an urban problem, whereas much less attention has been paid to air pollution and the associated health implications in rural areas. We take China as an example, and first show that air pollution in rural areas is no better than that in urban areas, using China’s firm-level waste gas emission data, grid-level PM2.5 (fine particulate matter) data and grid-level health data. We further reveal that high-speed rail has enabled urban areas to lower waste gas emission intensity, PM2.5 concentration and cardiovascular-disease-induced deaths to a greater extent than rural areas. Such intercity transportation infrastructure can, thus, widen urban–rural gaps in air pollution and public health. Then, we show that the unequal impacts of high-speed rail opening in urban and rural areas are associated with the spatial redistribution of resources in favor of urban areas. Finally, we point out that such unequal impacts grow over time, though with some fluctuations, and prevail at different geographical distances. This study seeks to influence how pollution is viewed in China and other emerging economies, by directing more attention toward air pollution and public health in rural areas and toward how urban–rural disparity may be widened by certain policy instruments.</p>