Context: Approximately 20% of North Americans and 25% of Europeans reside in rural areas. Planning and providing end-of-life (EOL) care in rural areas presents some unique challenges. Purpose: In order to understand these challenges, and other important issues or circumstances, a literature search was conducted to assess the state of science on rural EOL care. Methods: The following databases were searched for articles published from 1988 through 2003: EMBASE, Medline, CINAHL, AHMED, Psychinfo, ERIC, HealthStar, Sociological Abstracts, and Cochrane. All articles were systematically reviewed. Findings: Thirty-six research articles were identified. Only 1 randomized controlled trial was located. Most research was single site, small sample, and exploratory/descriptive in design. Four distinct foci in this body of research were noted: (1) identifying and describing differences between urban and rural EOL care; (2) exploring rural EOL care; (3) assessing the EOL needs and wishes of terminally ill or dying persons, their family members, and health care professionals in rural areas; and (4) exploring EOL education for rural EOL care providers. Conclusions: Although rural EOL care research is not extensive, the existing literature is helpful for realizing the importance of EOL care in rural communities, as well as for conceptualizing and planning EOL care in rural communities. One of the chief considerations for rural EOL care is that dying at home is a common wish, with home-based nursing care a key factor for this to become a reality. Another chief consideration is ensuring all rural health care professionals are both prepared for and supported while delivering EOL care.