African Americans have higher rates of nonprescription drug utilization than white Americans, but lower rates of prescription drug use. In light of this discrepancy, this study examines 281 lower income African American households in the rural South for access to prescription drugs and coping strategies when households cannot afford prescription drugs. About half of the households could not always afford needed prescriptions, and ability to pay was related positively to Medicaid coverage. Households that could not afford prescriptions employed five strategies: (1) prioritizing, (2) financing, (3) rationing, (4) substituting, and (5) postponing. Financing, postponing, and rationing were cited most frequently. The impact of culture and areas for future research are discussed.