Telehealth has been hypothesized as a solution for rural barriers precluding access to healthcare, of which distance remains one of the most significant. Providers, institutions, and policymakers may use distance as a metric to determine whether to keep, or to end, telehealth services. Although commonly used, straight line distance (SLD) may not reflect the true burden of distance (TD) for rural patients. A retrospective record review was conducted to determine the difference between SLD and TD for patients seeking behavioral health care at a large outpatient center. The discrepancy between SLD and TD ranged from 0.5 to 83.4 miles of additional actual travel distance (mean = − 17.6). The mean percentage that SLD underestimated TD was 31.9%. Findings highlight that when considering distance as a determining factor for telehealth services, SLD is an inaccurate representation of the travel burden on this sample of rural patients, suggesting the utility of TD as an alternative.