To describe the association between geographic location of residence and use of aneuploidy screening or prenatal genetic counseling, and how it is modified by maternal race and ethnicity. Retrospective cohort of individuals at a tertiary-care center between 2017-19. County of residence was classified as rural or metropolitan based on US Office of Management and Budget 2019 definitions. Maternal race and ethnicity were self-identified. Our composite outcome was defined as use of aneuploidy screening or genetic counseling visit. The composite outcome was compared by geographic location and ethnicity. Logistic regression was used to model the relationship between geographic location and the composite outcome. 8774 pregnancies were included. 4770 (54%) had genetic screening and 3,781 (43%) had at least one genetic-counseling (GC) visit. Rural patients were significantly less likely to have the composite outcome compared to metropolitan peers (37.1% vs. 47.2%, p<0.001). In addition, we identified differences in the composite outcome between White rural patients and LatinX rural patients (37.7% vs. 35.6%, p<0.001), and between Asian rural patients and LatinX and Black rural patients (41.0% vs. 35.6%, p<0.001; 41.0% vs. 36.8%, p<0.001). Logistic regression demonstrated rural patients were significantly less likely to have the composite outcome compared to metropolitan peers, after adjusting for LatinX ethnicity and gestational age at first prenatal visit (OR 0.72, [0.55, 0.95], p=0.002. Rural, minority patients were significantly less likely to receive reproductive genetic services compared to metropolitan peers extending our knowledge of disparities in maternity care.