Although one-quarter (25%) of custodial grandparents live in rural areas, less is known about these families than their urban counterparts. This qualitative study was conducted to determine pathways into care with rural families; that is, the reasons and process into custodial grandparenting roles. Based upon interviews with fourteen grandparents, three major pathways were identified. The most common was co-residential, where the parent generation exited a multi-generational household. In the incremental pathway, grandparents had attempted multiple strategies with the culmination of taking physical custody of the grandchildren. A final pathway, immediate care, was typically the result of a family crisis situation. Needs and challenges for custodial grandparents differ depending upon their unique pathway into this caregiving role.