BACKGROUND: Although prayer and other spiritual practices are common among residents of the rural south, the use of faith-based healers (FBH), or healers who use prayer as their primary healing modality, has not been explored in this population. METHODS: Secondary data analysis from a random digit dialing telephone survey of rural adults in eight southern states. RESULTS: Our overall response rate was 51% and 193 subjects (4.1%) had seen an FBH practitioner within the previous year. FBH use was significantly more common among younger respondents (OR 7.21, 95% Ci 2.00, 25.94), women (OR 1.49, 95% CI 1.03, 2.14), those reporting poorer health (OR 1.83, 95% CI 1.19, 2.83), and those who believed in avoiding physicians (OR 1.82, 95% CI 1.24, 2.67). A relationship between FBH use and delayed or foregone medical care, and cost as a barrier to obtaining care was not statistically significant after controlling for other factors. CONCLUSIONS: Prevalence of FBH use is low, but is significantly related to younger age, female gender, poorer health status, barriers to medical care and devaluing medical care. Clinicians may consider exploring FBH usage with their younger, female patients, and those in poorer health. Policy makers should consider how FBH usage is related to various indicators of health care services demand, utilization and access.