Background: Numerous epidemiological studies have demonstrated a possible correlation between high temperature and mortality in different settings. Most of these studies have focused on urban settings in industrialized countries, concluding that urban populations are more vulnerable to heat effects than rural populations. This has mainly been attributed to the urban heat island (UHI) effect, a phenomenon which explains the elevated temperatures in urban areas. Others have contradicted this finding and concluded that rural residents are more vulnerable. For this study, we test the hypothesis that rural populations and sub-populations are also vulnerable to heat mortality. Method: A comprehensive literature search was conducted using PubMed, Web of Science and Google Scholar to identify peer-reviewed studies investigating heat mortality in rural settings. Using keywords and a set of rigorous inclusion and exclusion criteria, ten studies were selected. Meta-analysis was then performed using the Comprehensive MetaAnalysis V3.exe software. Results and discussion: The pooled relative risk (RR) was 1.191 (95% confidence interval: 1.130-1.251). Although rural populations may not be exposed to as high temperatures as urban populations, they remain vulnerable to heat effects. Conclusion: There is evidence of heat vulnerability in rural populations and subpopulations. Heat vulnerability is not only determined by heat exposure, but also by sensitivity and adaptive capacity. Rural populations and sub-populations may be vulnerable to heat mortality due to low adaptive capacity. Further studies are needed to assess risk factors that predispose rural populations and sub-populations to heat mortality in order to develop effective public health interventions.