Motor vehicle crash (MVC) fatality rates have been shown to be inversely related to population density. The purpose of this study is to describe and compare crash variables of fatal MVCs between urban and rural regions, as well as among rural regions with different population densities. We retrospectively analyzed data from four midwestern states over the five year period from 1986 to 1990. The study population included 10,932 people in 6,318 vehicles involved in 4,296 crashes resulting in 4,970 fatalities. We found several variables that were related to population density which may help planners develop interventions for rural populations.