Cervical cancer is an important cause of cancer mortality in black women. Pap tests may prevent such deaths, but poor, rural black women are relatively less likely than others to be screened. In order to understand why that is so, the authors surveyed 149 women in three rural North Carolina counties. Thirty-three percent of the women interviewed had not had a Pap test in the preceding three years. Variables independently associated with not having a recent Pap test included: having no identifiable source of medical care; having more than one source of gynecologic care; having an internist provide gynecologic care; and perceiving psychological barriers to Pap tests and pelvic examinations. Income, educational level, and health insurance status were not associated with having a recent Pap test. Although access to care remains a problem for some, better use should be made of the medical care encounters available.