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The objective of this study was to document the social inequalities existing in both health status and health care utilization in rural areas of the Mexican state of Tlaxcala. Whilst previous studies on the subject undertaken in Mexico and elsewhere have focused on examining differences between heterogeneous socio-economic groups within urban areas and between urban and rural areas, this investigation concentrated on analysing differences between groups and communities within rural areas which are considered to be more homogeneous. Particular attention was paid to examining differences between agricultural and non-agricultural occupations and between agricultural groups. To compare the overall health of groups and areas, three different kinds of health measures were used: self-reporte