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Residence may influence cancer management. However, the role of residence in primary bone cancer is not well explored. In this study, patients diagnosed with primary bone cancer were identified from the surveillance, epidemiology, and end results (SEER) database and divided into urban and rural groups based on residence. Multivariable ordinal logistic regression was used to determine the relationship between residence and stage at diagnosis. Multivariable logistic regression was used to explore the association between residence and receipt of local surgery, radiotherapy, and chemotherapy. Propensity score matching (PSM) was used to balance the baseline between the 2 groups, and Kaplan-Meier curves were used to estimate the overall survival (OS) and cancer-specific survival (CSS) of the 2 groups. A total of 13,876 patients with primary bone cancer were included. Compared with urban patients, rural patients were less likely to receive local surgery (OR = 0.78, 95% CI: 0.70-0.89, P < .001), radiotherapy (OR = 0.69, 95% CI: 0.60-0.88, P < .001), and chemotherapy (OR = 0.85, 95% CI: 0.77-0.94, P < .001). After PSM, rural patients had significantly worse OS (HR = 1.10, 95% CI: 1.03-1.19, P = .029) and CSS (HR = 1.08, 95% CI: 1.02-1.18, P = .036) than urban patients. However, residence was not associated with the stage at diagnosis (Rural vs Urban, OR = 1.00, 95% CI: 0.88-1.14, P = .989). In conclusion, rural residence is associated with lower likelihood of receiving definitive treatments (local surgery, radiotherapy, and chemotherapy) and worse survival for primary bone cancer. However, residence is not associated with stage at diagnosis.