Falls are a leading cause of injury and disability among older adults. A systematic literature review of Cochrane Library, MEDLINE, CINAHL, and Internet was conducted to evaluate efficacy of rural, community-dwelling fall prevention programs. Four studies focusing on different fall prevention programs were evaluated: 1) tai chi, 2) medication review, 3) program of education, exercise, home safety, and nutritional counseling, and 4) a comparison of education, home safety, and exercise. Two studies directly measured fall reduction, tai chi (no difference) and medication review (mixed results). All four demonstrated improvements in some fall risk factors. These strategies may effectively reduce fall risk factors in the rural setting [Grade B]. Not enough evidence exists to make a recommendation regarding actual fall reduction.