The current study investigated relationships between anxiety symptoms and residential location on problem recognition, service use and resultant impact. Clinically significant differences between rural and urban residents were not found on mental health symptoms, problem recognition or history of service use. Parent and family interference was found to be strongly linked to a child’s anxiety level in both regions, with a child’s negative experiences and direct interference on the child’s life being attributed a smaller role. The impact of anxiety in rural areas was found to be higher than that experienced by similarly anxious children from urban areas. Finally patterns of service use were found to vary with a greater reliance on medical and school services in rural areas, and specialist and allied health services in urban areas. The findings together provide support for the development of specialised services for rural communities, and have implications for targeted education of parents to improve the number of children receiving appropriate help.