Objective: To examine perceptions of cervical cancer risk in elevated-risk Appalachians. Methods: Appalachian women (n=571) completed interviews examining self-regulation model factors relevant to perceived risk of cervical cancer. Results: Women with good/very good knowledge of cervical cancer, greater worry, and history of sexually transmitted infection had higher odds of rating their perceived risk as somewhat/ much higher than did other women. Former smokers, compared to never smokers, had lower risk perceptions. Conclusions: Self-regulation model factors are important to understanding perceptions of cervical cancer risk in underserved women. The relationship of smoking and worry to perceived risk may be a target for intervention.