Worldwide, stroke is the second leading cause of death and leading cause of disability. Women experience over half of all strokes, 60% of stroke-related deaths, and a death rate of 11% versus 8.4% for men. To understand the delay in stroke recognition and treatment, a convenience sample of 97 midlife women living in southeast North Carolina completed the Stroke Recognition Questionnaire. Rural women, younger women (<49 years old), and participants with incomes under $35,601 had higher stroke symptom and risk factor knowledge scores. Educational interventions should target women over the age of 50, and should distinguish between symptoms of stroke versus heart attack.