Many recent advances in machine learning are driven by a challenging trifecta: large data size $N$; high dimensions; and expensive algorithms. In this setting, cross-validation (CV) serves as an important tool for model assessment. Recent advances in approximate cross validation (ACV) provide accurate approximations to CV with only a single model fit, avoiding traditional CV's requirement for repeated runs of expensive algorithms. Unfortunately, these ACV methods can lose both speed and accuracy in high dimensions -- unless sparsity structure is present in the data. Fortunately, there is an alternative type of simplifying structure that is present in most data: approximate low rank (ALR). Guided by this observation, we develop a new algorithm for ACV that is fast and accurate in the presence of ALR data. Our first key insight is that the Hessian matrix -- whose inverse forms the computational bottleneck of existing ACV methods -- is ALR. We show that, despite our use of the \emph{inverse} Hessian, a low-rank approximation using the largest (rather than the smallest) matrix eigenvalues enables fast, reliable ACV. Our second key insight is that, in the presence of ALR data, error in existing ACV methods roughly grows with the (approximate, low) rank rather than with the (full, high) dimension. These insights allow us to prove theoretical guarantees on the quality of our proposed algorithm -- along with fast-to-compute upper bounds on its error. We demonstrate the speed and accuracy of our method, as well as the usefulness of our bounds, on a range of real and simulated data sets.