This analysis uses in-depth interview data collected from 145 AfricanAmerican, European American and Native American men and women aged 70and older who reside in two rural North Carolina counties to understand therole of religious faith and prayer in the health self-management of theseolder adults. The analysis addresses three specific questions: how do theseolder adults use religion to help them manage their health; are there ethnicand gender differences in the use of religion; and are differences in healthstatus related to differences in the use of religion? The integral role ofreligion in the lives of these older rural adults is an overarching themepresent in the interview texts. Six major themes link religion and healthself-management: (1) prayer and faith in health self-management, (2)reading the Bible, (3) church services, (4) mental and spiritual health, (5)stories of physical healing, and (6) ambivalence. Faith and religiousactivities provide an anchor in the lives of these older adults. There is littlevariation in the use of religion for health self-management by gender,ethnicity or health status. These results suggest that the strength ofreligion in rural culture may limit the effectiveness of general religiosityscales to discern the relationship of religion to health and health behaviorin rural populations.