While the process of dying is a universal human experience, it amplifies peoples’ cultural similarities and differences. Professional nurses have a duty to provide culturally congruent care that is satisfying, meaningful, and beneficial, fits with peoples’ daily lives and, in this context, helps them face end of life (EOL). This study addressed a gap in the literature by discovering the culture care EOL needs of rural Appalachian persons and their families at home. Themes abstracted related to faith, family care, integrating generic/folk and professional nursing care, hospice care decision-making, and recommended nursing interventions promote a satisfying death experience for this population. Since death is a part of life that eventually affects everyone, applying knowledge about personal and family values, beliefs, and practices at EOL is essential for promoting physical, emotional, and spiritual health, addressing health disparities, and facilitating a dignified death among rural Appalachians.