To comprehensively understand the law of urban-rural relationship and propose scientific measures of urban-rural coordinated development in Northeast China, this study uses the coupling coordination degree model and geographically and temporally weighted regression (GTWR) model to analyze the spatial-temporal patterns and the corresponding driving mechanisms of its urban-rural coordination since 1990. The results are as follows. First, the urban-rural coupling coordination degree in Northeast China was very low and improved slowly, but its stages of evolution is a good interpretation of the strategic arrangements of China’s urbanization. Second, the urban-rural coupling coordination degree in Northeast China had spatial differences and was characterized by central polarization, converging on urban agglomeration, which was high in the south and low in the north. Moreover, the gap between the north and south weakened. Third, the spatial-temporal evolution of the urban-rural coordination relationship in Northeast China was influenced by pulling from the central cities, pushing from rural transformation, and government regulations. The influence intensity of the three mechanisms was weak, but the pulling from the central cities was stronger than that of the other two mechanisms. Furthermore, the spatial difference between the three mechanisms determines the spatial pattern and its evolution of the urban-rural coordination relationship in Northeast China. Fourth, to promote the development of urban-rural coordination in Northeast China, it is essential to advance urban-rural economic correlation, enhance the government’s role in regulating and guiding, and adopt different policies for each region in Northeast China.