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Extreme smoke events from wildland fires are increasing in frequency and intensity across the country. Risk communication around wildland and prescribed fires is an essential component of both smoke-readiness and resilience. To date, little research has been conducted on how smoke exposure risks can be communicated effectively, especially within the context of rural and tribal communities, who experience a disproportionate burden of smoke risks and impacts. This qualitative study analyzed how tribal and non-tribal communities in the Okanogan River Airshed Emphasis Area (ORAEA) receive and share information about smoke exposure to highlight gaps and communication opportunities for smoke risk communication. The ORAEA is a region of north-central Washington that is frequently blanketed with smoke year-round from wildland fire in the summer, prescribed fire in the fall and spring, and wood burning stoves in the winter. This study was the result of a partnership between the Okanogan River Airshed Partnership, the Natural Resource Division for the Confederated Tribes of the Colville Reservation, the Colville Environmental Trust Air Quality Program, and the University of Washington. The study team conducted seventeen key informant interviews and six focus groups to identify community perceptions of smoke exposure and describe its impact. A thematic analysis of interview and focus group data identified five themes around wildfire smoke risk communication: (1) perception of the health risks of smoke; (2) current ways of sharing information about smoke; (3) trusted sources of information; (4) gaps and communication opportunities; and (5) perceptions of prescribed fire. Based on these themes, we developed a set of six recommended actions. To create effective smoke risk communication that may be applicable to smoke-impacted regions across the country, messaging must address barriers to action, be rooted in community perceptions of risk, and be delivered through trusted channels.