This article compares urban and rural household water insecurity experiences during the last major drought period (2011-17) in the semi-arid interior region of Ceara, Brazil. Using data from a household survey (N = 322), we determined that households in small urban areas are more and differently water insecure than rural counterparts. Factor analysis and an ordinal logistic regression pinpoint key dimensions, such as water distress, water-sharing and intermittency, contribute differently to water insecurity in rural and urban households. Policy recommendations are made.