Context: A small number of fatalities continue to occur due to motor vehicle crashes on highways in which at least 1 passenger vehicle (automobile, van, or small truck) is driven by a child younger than 15 years. Purpose: The purpose of this study was to extend previous work suggesting that such crashes occur frequently in the Southern states and have relatively high rates in rural areas in the South and Great Plains. Methods: This study utilizes data for the 5-year period 1999-2003 from the National Highway Transportation Safety Administrations online Fatality Analysis Reporting System. All cases were identified in which at least 1 conventional passenger vehicle in a fatal crash was being driven by a child younger than 15 years. Findings: During the 5-year period, 350 fatal crashes occurred with at least 1 driver younger than 15 years involved. Twenty-one of these drivers were licensed (11) or driving with a learners permit (10). A total of 987 individuals in 419 vehicles were involved in these crashes, and 402 deaths resulted (1.16 deaths/crash). These crashes occurred primarily in Texas, Florida, Arkansas, and Arizona, but the highest rates per 100,000 children were found in North and South Dakota and predominantly in a band of Intermountain and Plains states. There was a strong correlation between crash rates and several measures of rurality. Conclusions: Crashes involving young, largely unlicensed, drivers account for about 70 deaths yearly.