Currently, little is known about the role of nurses' aides (NAs) in rural long-term care facilities or their impact on the process of death and dying in rural healthcare environments. Focus groups with NAs were held in 6 rural counties located in 5 states to assess attitudes and perceptions about end-of-life care and training needs. Key informants from 8 states and the District of Columbia added to the understandings. Nurses' aides (N = 63) and key informants (N = 21) worked in a variety of rural settings that provide end-of-life care (ie, nursing homes, hospitals, hospices, home healthcare agencies). Five themes about the needs of rural NAs around end-of-life care were identified in the focus groups, and 4 themes emerged from key informant interviews. A prototype computer-based training module on communication about end-of-life issues was developed, tested, and found useful and compelling.