["Journal of Traumatic Stress, EarlyView. ", "\nAbstract\nLesbian, gay, bisexual, transgender, and queer (LGBTQ+) individuals experience elevated rates of trauma exposure, minority stress, and posttraumatic stress disorder (PTSD). Yet, research examining how geographic location and LGBTQ+ identity shape PTSD outcomes is scant, particularly studies considering structural facilitators and barriers, such as health care access. This cross‐sectional, secondary study investigated associations between several individual‐ and structural‐level factors and PTSD symptoms in LGBTQ+ adults (N = 131) recruited from urban and rural U.S. regions, most of whom identified as non‐Hispanic White, bisexual, cisgender women. Analyses examined whether intersecting demographic characteristics, urban or rural location, perceived health care access, LGBTQ+ identity disclosure to providers, and experiences of LGBTQ+ discrimination were associated with PTSD symptom severity and probable PTSD diagnosis. Approximately 62% of participants reported experiencing a DSM‐5 Criterion A traumatic event; of these individuals, 24.4% met the criteria for probable PTSD. General health care access, β = −.27, 95% CI [−.45, −.09], p = .003, and LGBTQ+ identity disclosure, β = −.19, 95% CI [−.31, −.07], p = .039, were significantly associated with PTSD symptom severity. Higher health care access was associated with 50.0% lower odds of probable PTSD, ORadj = 0.50, 95% CI [0.29, 0.84], p = .009. Bisexual cisgender women had 4‐times higher odds of a probable PTSD diagnosis compared to LGQ+ participants, ORadj = 3.96, 95% CI [1.15, 13.7], p = .030. Improving access to health care and supporting identity disclosure may reduce PTSD risk among LGBTQ+ adults, especially for bisexual cisgender women and rurally situated individuals.\n"]