In 1977, Michael Lipton introduced the Urban Bias Thesis as a framework for understanding how most economic policy initiatives have contributed to the overdevelopment of urban areas and the underdevelopment of rural areas. In Latin America, there has historically been a positive correlation between urbanization and mortality decline, as the region’s health transition generally began in the main cities and tended to proceed more rapidly in countries with higher levels of urbanization. This paper seeks evidence of a residual urban bias in the region’s mortality patterns. Using a sample of Latin American countries over the 2000–2010 period, I analyse the disparities in mortality patterns and avoidable causes of death by looking closely at urban and rural areas using continuum categories. The results indicate that the urban advantage does persist and that rural–urban mortality differentials have consistently favoured the largest cities. The metropolitan advantage in mortality is an outcome of lower mortality in causes of death that are avoidable through primary interventions. Even in scenarios of high mortality at younger adult ages (15–44), the metropolitan advantage remains, due primarily to unsuccessful efforts to reduce mortality in populations aged 45 years and over outside the main and large cities.