Nicoli CD, et al. - In early-stage non–small cell lung cancer (NSCLC) patients from National Cancer Data Base, the relationship between rural residence with survival outcomes and receipt of guidelines-concordant treatment was investigated. Of 840,566 patients, 18.7% resided in rural areas. Rural stage I patients vs nonrural patients had larger proportions who did not undergo guidelines-concordant management with lobectomy or stereotactic body radiation therapy. Multivariable Cox regression revealed an independent association of rurality with impaired survival in all-stages and stage I NSCLC. Rural patients at each stage of diagnosis have a significant difference in overall survival, but stage I NSCLC had the greatest absolute difference.