BACKGROUND Gun violence continues to be a source of trauma patient morbidity and mortality annually in the United States. We sought to characterize gun violence in the combined suburban and rural county of Lancaster, PA, and compare it with gun violence results obtained in urban areas. METHODS All gunshot wound (GSW) admissions from January 2000-December 2013 were queried from trauma registry. Patients sustaining ball bearing/ball bullet (BB) or pellet gun injury were excluded. Data collected included mortality, injury severity score (ISS), number of GSW per patient, and cost data. Linear trend tests assessed the change in mortality, patients with three or more GSWs, and patients with an ISS ≥15 and ISS ≥25 over the study period. Statistical significance was defined as P < 0.05. RESULTS A total of 478 patients met our inclusion criteria. Linear trend tests revealed no significant changes in percent mortality (P = 0.973), percent of patients with three or more GSWs (P = 0.692), percent of patients with an ISS ≥15 (P = 0.545), and percent of patients with an ISS ≥25 (P = 0.343) over the 14-y study period. No significant change in cost per case was observed over the study period (P = 0.246); however, percent reimbursement significantly increased (P = 0.012). CONCLUSIONS In the relatively affluent suburban and rural community of Lancaster, PA, there is a low-level pattern of gunshot violence and subsequent mortality that has not changed over time. This continuing pattern of gunshot violence speaks to the need for development of innovative preventative measures, as well as continuing efforts against gunshot violence by health care and law-enforcement personnel in suburban and urban centers alike.