To better understand the factors influencing patients’ ability to get care, researchers compared the distribution of urologists across counties in the United States since 2000 to regional shifts in the general population. Data from the U.S. Census Bureau, the American Community Survey, and the Department of Health and Human Services were examined at the county level for the years 2000, 2010, and 2018. The number of urologists per 10,000 people in a given area is the measure used to characterize the availability of urologists in each county. Geographically weighted regression and multinomial logistic regression were carried out. The results of 10 rounds of cross-validation were used to create a prediction model (AUC=0.75). Although the number of urologists has increased by 6.95% over the past 18 years, access to a nearby urologist has decreased by 13% (-0.03 urologists/10,000 people, 95% CI 0.02-0.04, P<0.0001). The existence of urologists in the area previously (OR 1.49, 95% CI 1.16-1.89), and metropolitan status (OR 1.86, 95% CI 1.47-2.34), were the 2 strongest predictors of urologist availability in a multiple logistic regression analysis. However, the significance of these elements as predictors differed across the United States. The availability of urologists has declined across the board, but the problem is especially acute in rural areas. Although people have been migrating out of the Northeast in large numbers to the West and South, the Northeast has been the only region with a decline in the total number of urologists (-1.36%). The overall population growth and uneven regional migration over nearly 20 years led to a nationwide shortage of urologists. Given the variation in regional predictors of urological availability, it will be essential to examine regional forces impacting population movements and urologist concentration to forestall the widening of existing gaps in service.