Cardiovascular disease (CVD) is a major cause of morbidity and mortality in the United States and aspirin is a well-known medication strongly associated with CVD prevention. Aspirin has undeniable benefits in the role of secondary prevention of CVD, however, the benefits are ambiguous when associated with primary prevention. The decision to start aspirin for primary prevention becomes complicated due to aspirin’s effect on coagulation and the risk of gastric ulceration. The United States Preventive Services Task Force (USPSTF) has level B recommendations in place regarding the use of low-dose aspirin (81 mg) for primary prevention of CVD. In addition, the American Heart Association (AHA) and American College of Cardiology (ACC) developed a calculator in 2013 to determine a patient’s 10-year CVD risk. The guideline and CVD calculator offer healthcare providers an easy-to-navigate tool to determine proper patient use of aspirin. However, despite the USPSTF guideline, appropriate aspirin use remains suboptimal. Successful adoption of the 2016 USPSTF guideline on aspirin use for primary prevention of CVD by providers in two rural North Dakota communities was the goal of this practice improvement project. The project began with education to providers and staff at the rural clinics regarding the USPSTF guideline and the ACC/AHA calculator. Following the educational session, implementation of the USPSTF guideline occurred for three months. Evaluation was performed through the use of a post-implementation survey. Results of the project demonstrated increased knowledge and usage of the guideline and a positive viewpoint related to implementation of the guideline with the providers in both of the communities having plans to sustain use in future practice. Data were also collected at a health screening fair in one of the rural communities to validate whether patients were taking aspirin per USPSTF guideline. Data gathered from the fair concluded only 59% of patients (41 out of 70) were taking, or not taking, aspirin appropriately according to the USPSTF guideline. Conclusively, primary care providers would be well served by using the ACC/AHA calculator and 2016 USPSTF guideline with all patients 40-79 years of age to determine appropriate use of aspirin for primary prevention of CVD.