Despite the health benefits of physical activity, many women remain inactive and the needs of rural women are understudied. To understand access to physical activity barriers, opportunities, and intervention preferences in rural women and determine how these differ by self-reported activity level. A mailed questionnaire was distributed to 900 rural women and included measures of physical activity, health status, barriers, opportunities for exercise, and preferences for intervention type, components, and delivery. Questionnaires were completed by 507 women; 72.0% reported meeting the physical activity guideline. Inactive women reported greater barriers to activity (higher scores on 18 of 22 barriers; p < 0.05), less access to or usage of 8 of 9 places to exercise (p < 0.05), and less belief in the relevance of physical activity to personal health (p < 0.001). Both inactive and active women were most interested in programs that use walking, yoga, or strength training. Physical activity interventions for rural women need to address their specific needs, including barriers to physical activity and lower access to places in which to be physically active.