Background: Although the relationship between diet and disease is well established, sustainable dietary changes that would affect risk for disease have been difficult to achieve. Whereas individual factors are traditional explanations for the inability of some people to change dietary habits, little research has investigated how the physical availability of healthy foods affects individuals’ diets. This study examines the distribution of food stores and food service places by neighborhood wealth and racial segregation. Methods: Names and addresses of places to buy food in Mississippi, North Carolina, Maryland, and Minnesota were obtained from respective departments of health and agriculture. Addresses were geocoded to census tracts. Median house values were used to estimate neighborhood wealth, while the proportion of black residents was used to measure neighborhood racial segregation. Results: Compared to the poorest neighborhoods, large numbers of supermarkets and gas stations with convenience stores are located in wealthier neighborhoods. There are 3 times fewer places to consume alcoholic beverages in the wealthiest compared to the poorest neighborhoods (prevalence ratio [PR]0.3, 95% confidence interval [CI]0.1– 0.6). Regarding neighborhood segregation, there are 4 times more supermarkets located in white neighborhoods compared to black neighborhoods (PR4.3, 95% CI1.5–12.5). Conclusions: Without access to supermarkets, which offer a wide variety of foods at lower prices, poor and minority communities may not have equal access to the variety of healthy food choices available to nonminority and wealthy communities.