Mental health problems are common in the general population. The aim of this study was to investigate differences in frequencies of self-reported psychiatric symptoms, harmful alcohol use and healthcare contacts, in an urban and a rural area in Sweden. Two samples of 10,441 (urban site) and 3538 (rural site) subjects, aged 20-64, responded to a questionnaire, covering demographic characteristics and self-report psychiatric instruments as well as contact with healthcare during the past 12 months. Psychiatric symptoms and symptoms of substance abuse were reported by 17% of the urban women compared with 13% of the rural women, and by 20% of the urban men compared with 15% of the rural men. This difference is mainly due to an uneven age distribution in the two populations and remains statistically significant only in the oldest age group (50-64 years). Symptoms of anxiety and depression occurred with similar frequencies in both samples. Harmful alcohol use was reported by 3.6% of the urban women, 1.5% of rural women, 11.8% of urban men and 8.6% of rural men. The urban sample had more often been in contact with medical services, 77% vs. 52%. Symptoms of anxiety and depression were equally common in the two samples. Harmful use of alcohol was more common in the urban sample, especially among women. Most obvious was the stronger inclination to seek help in the urban sample.