This study assessed health-related changes of participants attending A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) model falls-prevention program for older adults based on their residential location. Data were examined from 1,482 older Texans enrolled in AMOB/VLL over a 2-year period and assessed at baseline and postintervention. Results indicate participants significantly increased falls efficacy by an average of 14.4% ( p < .01), reduced activity interference due to their health by an average of 6.5% ( p < .01), and decreased the number of days limited from usual activity by an average of 28.2% ( p < .05). Regression models show that rural participants, despite entering and exiting the program with lower health status, report greater rates of positive change for falls efficacy and health interference compared with their urban counterparts. Findings contribute to the understanding of geographic variation with falls-prevention program outcomes.