Influenza is a common and highly contagious upper respiratory illness that affects an average of 8% of Americans each season. The flu was associated with 18 million medical visits, 400,000 hospitalizations, and 22,000 deaths during the 2019-2020 flu season in the United States (US). The best protection from the flu is to receive an annual vaccination. However, only 56.5% of North Dakotans received a flu vaccine for the 2019-2020 season, well below the Healthy People 2030 goal of 70%. Suboptimal vaccination rates, along with increasing vaccine hesitancy and misinformation associated with the COVID-19 pandemic, make efforts in improving vaccine uptake extremely important to prevent future pandemics. The purpose of this practice improvement project was to increase patient access and provider knowledge of the flu vaccine. The project took place in a primary care clinic in Ellendale, North Dakota. Project implementation occurred from October 1, 2021 through November 30, 2021. Implementation began with education to one provider and two nurses on making recommendations using a presumptive approach, flu vaccine facts and recommendations, and considerations during the COVID-19 pandemic. Informational posters and flu vaccine reminders were displayed in clinic exam rooms and patient areas. Evaluation included an online survey utilizing 5-point Likert scales and manual chart review. Chart review of 75 random patient encounters between October 1 and November 30 of the years 2019, 2020, and 2021 was conducted for a total of 225 charts. Participants felt they were knowledgeable about the flu vaccine, recommendations for vaccine administration, and contraindications to vaccination after project implementation. Participants were also confident making recommendations for flu vaccination using a presumptive approach and recommended the vaccine most of the time during patient encounters.Education, visual reminders, and using a presumptive approach to recommend vaccination correlated with an overall improvement in missed opportunities for influenza vaccination. Despite a decline in flu vaccination rates seen in the state of North Dakota since the 2019-2020 flu season, vaccination rates in the primary care clinic in Ellendale improved by eight percentage points from 2020 (34.67%) to 2021 (42.67%) and doubled since 2019 (21.33%) with the implementation of simple interventions.