We conducted a qualitative content analysis of barriers to nursing home admission for rural residents. Data came from semi-structured interviews with 23 rural hospital discharge planners across five states (Georgia, Idaho, Minnesota, Pennsylvania, and Wisconsin). From those, we identified four themes around non-medical barriers to rural nursing home placement with particular salience in rural areas: financial issues; transportation; nursing home availability and infrastructure; and timeliness. We also identified policy and programmatic interventions across four themes: loosen bureaucratic requirements; improve communication between facilities; increase rural long-term care capacity; and address underlying social determinants of health.