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Purpose: Describe primary care providers' (PCPs) barriers and facilitators to implementation of lung cancer screening programs in rural settings., Methods: We conducted qualitative interviews with PCPs practicing in rural Oregon from November 2019 to September 2020. The interview questions and analytic framework were informed by the 2009 Consolidated Framework for Implementation Research. We used inductive and deductive approaches for analysis., Results: We interviewed 15 key participants from 12 distinct health care systems. We identified several Consolidated Framework for Implementation Research factors affecting lung cancer screening implementation. 1) Most PCPs did not have workflows to assist in discussing screening and relied on their memory and knowledge of the patient's history to prompt discussions. PCPs supported screening and managed the patient throughout the process. 2) PCPs reported several patient-level barriers, including geographic access to lung cancer screening scans and out-of-pocket cost concerns. 3) PCPs reported that champions are necessary to create opportunities for local practices to adopt lung cancer screening programs., Conclusions: Rural-practicing PCPs were supportive of lung cancer screening, however workflow processes, time challenges, and patient-reported barriers remain impediments to improved screening in their clinics. We identified several areas for improvement in lung cancer screening implementation in rural primary care practices, ranging from designing clinic workflows and processes to designating clinic staff to support referral, screening, and follow-up care for patients., Competing Interests: Conflict of interest: CGS serves in several administrative roles for lung cancer screening program in the Veterans Health Administration and does not receive financial compensation for that role. He has no professional affiliation with any study participant. He served on the American Lung Association panel to develop an online toolkit to support lung cancer screening efforts and received no financial compensation for that role. The author authors have no conflicts of interest to disclose., (© Copyright by the American Board of Family Medicine.)