OBJECTIVES Despite Ontario’s universal healthcare system, differences exist in healthcare accessibility and quality across the province. The objective of this study is to assess healthcare resource utilization for patients with ankle sprains based on rurality. METHODS Data on individuals who sought medical attention for ankle sprains between 2003 and 2011 in Ontario were obtained from multiple databases linked through the Institute for Clinical Evaluative Sciences (ICES).  The Rurality Index of Ontario (RIO) was used to measure the rurality level of patients based on their population density and geographic distance to healthcare facilities. Demographic characteristics were obtained for each of five RIO categories.  Healthcare utilization (number of visits to primary care physicians, specialists and ambulatory care) and physician billing costs were obtained and compared among the RIO categories.   RESULTS Between 2003 and 2011, the Ontario Health Insurance Program was billed $64 million and $36 million (2013 CAD) by specialists and general practitioners, respectively, for the treatment of ankle sprains and dislocations.  Approximately $116 million was spent on direct and indirect costs of emergency room visits for ankle sprains and dislocations.  The largest proportion of rural injuries occurred in the top income quintile.  Patients in the most rural RIO category saw specialists least often and had the highest number of ambulatory care visits. However, specialist visits constituted higher costs when compared to GP visits.  The highest specialist costs found were for males, elderly patients, and those who sought medical attention during winter.  The observed statistical differences in cost of GP visits across RIO categories were not clinically meaningful. CONCLUSIONS The differences in healthcare utilization between RIO categories may indicate a lack of access to specialist care with those residing in rural areas relying on emergency departments for care.  These results may be useful in allocating future resources to better serve rural patients.