The objective of our study was to determine if rural residence was associated with an increased risk of drowning in Ontario, Canada. We conducted a retrospective cohort study of all unintentional drowning deaths in Ontario Canada from 2004 to 2008. Age-adjusted mortality rates for males and females living in rural and non-rural areas were calculated using direct standardization, with non-rural residents as the reference population. We identified a total of 564 unintentional drowning deaths. The majority (89%) of fatal drowning victims were male, and 75% percent of victims were from non-rural area. Excluding bathtub drowning deaths, the age-adjusted drowning mortality rate was significantly higher for both males (rate ratio 2.8; 95% CI, 2.3- 3.4) and females (rate ratio 2.8; 95% CI 1.5- 5.0) from rural compared to non-rural areas. In Ontario, rural residence was associated with an increased risk of unintentional drowning.