This paper describes findings from focus groups conducted as formative evaluation in planning a dietary intervention for hypercholesterolemia in rural North Dakota and Minnesota. The researchers were interested in learning about attitudes, beliefs, and behavior in the areas of screening for high cholesterol, experience with dietary changes to lower cholesterol, experience with physicians as a source of dietary advice, and reactions to several dietary interventions. In response to questions regarding the efficacy of dietary treatment, a common belief was that an individual's cholesterol level was largely determined by genetics. Participants indicated that pressure from children to buy and prepare certain foods, social eating, eating out, time constraints, and missing the taste of favorite high-fat foods made dietary change difficult. Participants gave examples of how advice from their physicians had been too extreme and too general or vague. Focus group participants indicated that (1) frequent follow-up the first year is needed to maintain motivation; (2) food records should be prescribed by the physician in order to increase self-monitoring compliance; (3) materials should provide specific skill-building advice; (4) repetition reduces confusion; and (5) classes should be led by a health professional. Recommendations are made for nutrition education programs designed for rural populations.