We assessed how commonly people in the rural South perceive racial barriers to care, the characteristics of the people among whom this perception is most common and whether this perception is associated with satisfaction with and use of health services. We analyzed telephone survey data collected in 2002–3, using weighted statistical techniques and multivariate logistic regression in analyses stratified by race. Fifty-four percent of African Americans and 23% of Whites reported that they perceive racial barriers to care in their communities. African Americans who were middle-aged or older, male, or who report being in good-to-excellent health were more likely to perceive racial barriers. Whites who were younger, less educated, and uninsured were more likely than other Whites to perceive racial barriers. For African Americans, perceptions of racial barriers were associated with lower likelihood of being satisfied with care, but not with use of preventive services. The perception of racial barriers to health care is prevalent in the rural South, especially among African Americans. The consequences of this perception may include mistrust and dissatisfaction with medical care.