A former VIP casino hostess at Harrah's accused Roethlisberger of raping her in his penthouse suite in July 2008, when Roethlisberger was at Lake Tahoe for a celebrity golf tournament. The lawsuit also named Harrah's employees and executives, whom she accuses of orchestrating a cover-up of the incident.
Roethlisberger has denied the allegations. The woman never filed a formal criminal complaint with police.
Lawyers for the two-time Super Bowl champion had wanted to move the case to Minden in Douglas County, where Harrah's is located. They argued that Washoe County was an improper venue because, while one other defendant owned a home there, no defendants lived there.
But the high court rejected that argument, noting that Roethlisberger lacked standing to seek a venue change.
"We're delighted with the court's ruling and look forward to proceeding with the case in 2nd Judicial District Court," the woman's lawyer, Cal Dunlap, told The Associated Press when contacted by telephone.
David Cornwell, one of Roethlisberger's attorneys, said the Supreme Court ruling "does not affect the likely outcome of this case."
In an emailed statement, Cornwell said after considering the woman's own words, "the jury will conclude that Ben has been falsely accused."
Justices also said that if Roethlisberger were the only defendant and lives out of state, under Nevada law the woman could have filed her suit in any county in the state.
They also rejected arguments that the trial should be moved to Douglas County for convenience of witnesses and to ensure justice.
"The record contains no evidence demonstrating that the convenience of the witnesses compels a change in venue or that holding the trial in Douglas County rather than in Washoe County would promote the interests of justice," the ruling said.
"The difference in travel times to the courts in either county are, for many witnesses, relatively minimal," justices said, adding that while Roethlisberger may receive a speedier trial in Douglas County, the lower court judge did not abuse his discretion by retaining the case 50 miles north in Washoe County.
The woman in the Tahoe case is not the only one to allege being sexually assaulted by the quarterback. Roethlisberger was suspended for the first four games of last year's season for violating the NFL personal conduct policy. He was accused in March 2010 of the sexual assault of a 20-year-old college student, but a prosecutor in Georgia declined to bring charges.
He led the Steelers last year to another Super Bowl appearance, and acknowledged the need to restore his public image.
"Big Ben," as he's known, is now a newlywed. He married Ashley Harlan, a 26-year-old physician's assistant, on July 23 in Pittsburgh.