We investigate the impact of neighborhood structural characteristics, social organization, and culture on self-rated health in a large, cross-sectional sample of urban adults. Findings indicate that neighborhood affluence is a more powerful predictor of health status than poverty, above and beyond individual demographic background, socioeconomic status, health behaviors, and insurance coverage. Moreover, neighborhood affluence and residential stability interact in their association with health. When the prevalence of affluence is low, residential stability is negatively associated with health. Neighborhood affluence also accounts for a substantial proportion of the racial gap in health status. Finally, collective efficacy is a significant positive predictor of health but does not mediate the effects of structural factors.