Objective: As a first step in planning interventions to promote exercise in rural breast cancer survivors (BCS), we sought to determine the exercise preferences of rural BCS and to identify the major determinants of these preferences. Methods: Self-administered mail survey to a population-based sample from a state cancer registry. Results: Among the 483 respondents, 96% were White with mean education of 13±2.5 years and mean months since diagnosis of 39.0±21.5. Only 19% reported ≥150 min of moderate to vigorous physical activity per week. Although up to half were open to various counseling options, the most popular options were counseling after treatment (36%), face-to-face (47%), and from an exercise specialist (40%). Rural BCS preferred home-based (63%), unsupervised (47%), moderate intensity exercise (65%) that was primarily walking. The strongest preference correlates include higher education with exercise specialist, higher environment score with outdoors, more comorbidities with low intensity and counseling after cancer treatment, higher social support with exercising with friends or family, sedentary or insufficient physical activity with low intensity, and lower household income with preferring supervised exercise. Conclusions: Interventions designed to promote exercise among rural BCS are needed. Such interventions should consider the environmental aspects of this population and include multiple options based on the preferences of targeted subgroups. Copyright © 2009 John Wiley & Sons, Ltd.