Past city lights and the glow of suburban strip malls, America's roads get dark, lonely, and deadlier.
Fewer traffic lights and stop signs mean there's more room to speed. Often, a straight run can lead into tight curves with steep drop-offs or deep forest beyond. In many states, including Pennsylvania and New Jersey, whitetail deer abound and dart into traffic.
If a motorist crashes in rural areas, it could take much longer to get to a trauma center than in more urban settings.
Another reason rural roads are more deadly: A recent Centers for Disease Control and Prevention study found that people in rural areas are less likely to wear seat belts.
The report, released last week, said America's most rural counties had motor-vehicle death rates "three to 10 times higher than those in the most urban counties." It found that 44.4 percent of drivers and passengers were not buckled at the time of a fatal crash in urban counties, compared with 61.3 percent in rural counties.
The worst death rates were in the West, with 40 per 100,000 in rural areas and 3.9 in urban counties. The Northeast fared the best, with a rate of 10.8 in rural counties and 3.5 in urban counties.
"Although we know motor vehicle crash-related deaths have been historically higher in rural areas, this study shows that the more rural the area, the higher the risk," said Laurie Beck, an epidemiologist in the CDC's Division of Unintentional Injury Prevention.
Seat belt laws have a lot to do with those rates. People buckle up more in "primary enforcement" states, where a police officer can pull over and ticket drivers and passengers for not wearing one. In secondary enforcement states, a passenger or driver can be ticketed only if another offense has occurred.
A large swath of Western states are secondary enforcement states. Pennsylvania is, too.
In New Jersey, where a motorist can be pulled over for not wearing a seat belt, the state's more rural counties, including Cumberland and Salem, had higher death rates for every one million miles driven
A 2014 Pennsylvania Department of Transportation report found that the lowest rates of seat belt usage in crashes were in Beaver County and Philadelphia. They were followed by Potter and Greene Counties, two of the states's most rural. The same report showed that although far more pedestrians were injured in "cities," more were killed in "townships," "perhaps due to higher vehicle speeds on rural roads."
According to PennDot's interactive crash tool, there were 617 fatal motor vehicle crashes from 2014 to 2016 in Philadelphia, Delaware, Montgomery, and Allegheny Counties, four of the state's most urban. A driver or passenger was not wearing a seat belt in 181, or 29 percent, of those crashes.
In Forest, Cameron, Potter, and Sullivan Counties, the state's most rural areas, there were 13 fatal motor-vehicle crashes from 2014 to 2016. Someone was unbelted in nine — 69 percent — of those crashes.
Ashley Schoch, a PennDot spokeswoman, said Gov. Wolf's administration has dedicated $3 million to seat belt enforcement this year.
"Since each crash is unique, we cannot speculate on crash causes, although national data suggests that human error causes more than 90 percent of crashes," Schoch said in a statement. "PennDot continues to focus its efforts on safety including: education, targeting behavior change, and increased seat belt use."
Nichole Morris, director of the HumanFIRST Laboratory at the University of Minnesota, said there may also be a cultural component to the lack of seat belt use in rural areas.
"Pickup truck drivers are less likely to use seat belts than drivers of other motor vehicles," she said.
According to consumer reports, the average car is on the road for 11 years, but Morris said residents in rural areas could be driving older vehicles.
"They also deal with less access to Uber and Lyft," Morris said. "The cities make it so easy to not drive drunk."