All individuals deserve to have access to quality end-of-life care. In rural communities within the United States, significant barriers limit access to hospice and palliative care. They include issues related to geography and supply, health care system eligibility criteria, limitations of the available workforce, educational deficits, and differences in cultural values. This article examines the barriers and potential solutions to address the gaps in hospice and palliative care services in rural communities. Strategies are proposed to strengthen hospice and palliative care delivery models to enhance earlier referrals and provide better facilitation and transition to hospice and palliative care. Future research should look at patient utilization questions specific to rural communities.