Rural communities typically have less access to mental health care, compared to urban communities. Two-way message-based asynchronous therapy is a potentially viable option to bridge this access gap, as it alleviates barriers associated with rural mental health access (e.g., travel, scheduling, and time lost from work or care of dependents). This study evaluated the pre–post treatment gains of a two-way message-based asynchronous therapy service, Talkspace, by comparing pre–post treatment outcomes between rural (N = 222) and urban (N = 238) clients, using the Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9). We also compared therapeutic alliance scores. Results demonstrated statistically significant pre–post improvement on both outcomes measures for both rural and urban clients, supporting the benefit of utilizing two-way message-based asynchronous therapy as a treatment modality. In addition, we found that rural clients had significantly better depression outcomes compared to their urban counterparts. We conclude our study by calling for more exploratory research on the interplay between sociocultural identities (including rural identities) and telemental health treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved)