Although the risk of serious head injury for horse riders is higher than for most other sports, few equestrians regularly wear protective headgear. This study indicates that riders are well informed about the need for helmets and that the main reason for nonuse is inadequate helmet design. In particular, riders perceive that existing helmets are uncomfortable, expensive, and inappropriate for some riding styles. Based on these findings, the authors developed strategies to increase usage and incorporated them into a successful program. These strategies included working with manufacturers to develop a low-cost, versatile helmet; efficiently distributing educational literature among the horse riding community; and encouraging individual clubs and equestrian organizations to mandate a helmet policy.