The focus of this study is roadway safety in American Indian tribal lands. American Indians’ motor vehicle crash fatality rate is the highest among all ethnic and racial groups in the United States. Roadway safety in tribal areas, where approximately 656 fatalities occur each year, is an important aspect of this problem. Following a review of crash statistics from recently published research, we present our empirical analysis of the expressed concerns of roadway safety managers with the most informed, direct knowledge of reservations and tribal areas. The data source is the 2016 Tribal Transportation Safety Data Survey, including 151 tribal government and 22 state government respondents. Qualitative methods were used to analyze their perceptions and priorities for roadway safety. We identified: 1) tribes’ and states’ highest priorities for roadway safety in tribal lands, and 2) their concerns about state government relationships relating to data quality, data sharing, and coordination. Tribes consistently named four concerns: road quality engineering and repair; reckless driving (speeding, impaired, distracted driving); seatbelt/car seat use; and pedestrian safety. Tribes and states both expressed a wish to improve their relationships, particularly relating to data quality and sharing, with both sides identifying the need for tribes to have more resources for data documentation and analysis. We conclude with recommendations to improve tribal roadway safety plans, strengthen data quality, create a common framework for identifying roads of interest to tribal governments and communities, and conduct additional research on pedestrian safety, emergency medical service response, roadway departures, and nonfatal crashes.