Although progress has been made in addressing hunger and poor diets in African cities, many urban residents still suffer from food insecurity, and there is large heterogeneity within cities. We examine spatial variations in hunger and dietary quality using a representative study of 983 households and 440 food retailers in a South African secondary city. Substantial variation existed both between and within urban neighborhoods: high-income neighborhoods were not free of hunger, and low-income neighborhoods varied in diet quality according to individual characteristics. After controlling for income and gender, individual characteristics including access to consumer technologies for food transportation and storage, and informal food assistance from neighbors, were protective against hunger and poor quality diets. Results suggest that meaningful variations exist at smaller geographic units than the city-level or neighborhood-level statistics typically reported in food security research. Average socioeconomic status of neighborhoods may not be a sufficient proxy for their food insecurity, as poor areas vary substantially in their food access options and food choices. Precision estimates of hunger and poor diets are needed to target interventions at those neighborhoods and those households with the greatest need, and to tailor interventions for the specific and different needs of urban residents within neighborhoods.