Whereas most traffic crashes occur in urban areas, the rates of fatal crashes and traffic fatalities (per capita and per vehicle mile) are higher in rural areas. The distinction between rural and urban areas is, therefore, an important delineation in any policy discussion about traffic safety. In particular, efforts to distinguish between rural and urban traffic safety should focus on those factors that increase the risk of fatal outcomes in rural areas. Notably, several aspects of the rural road environment can be characterized as hazardous. For example, several road design elements of rural roads, such as high speed limits, narrow shoulders with ditches, and the absence of median barriers can increase the risk of fatal crash types, such as head-on and rollover crashes. Moreover, the low population density and geographic isolation of rural communities can increase detection, response, and travel time for emergency medical services, thereby reducing crash survivability. In addition, the human factors associated with common impairment states and driving behaviors amongst rural drivers are also significant contributors to rural fatal crashes. The social forces that enable these human factors are embodied in the culture of rural communities. Indeed, comparisons of traffic safety performance between different countries have highlighted the importance of social attitudes, safety behaviors, and traffic safety policy in reducing fatal traffic crashes (Page 2001). Thus, it is necessary to consider the human factors associated with fatal rural crashes together with the relevant socio-cultural context of rural communities. Only by understanding the psychological and social factors that define the rural safety culture may it then be possible to development human-centered and culturally sensitive programs to improve traffic safety in rural America.