According to the National Institute for Occupational Safety and Health hearing loss is the third most prevalent condition after high blood pressure and arthritis in the United States (U.S.) (NIOSH, 2019). An estimated 22 million U.S. workers are exposed to hazardous noise, making noise induced hearing loss (NIHL) the second most self-reported occupational disease or injury. Although most industries are regulated by government organizations such as NIOSH and the Occupational Safety and Health Administration, agriculture does not fall under regulations and policies enacted through these groups. The incidence of hearing loss is high in farmers and agricultural workers, reflecting an increased need for screening. Unfortunately, even with the high prevalence of NIHL in farming populations, there is a gap in pragmatic screening techniques among care providers. The purpose of this practice improvement project was to a) identify and screen rural North Dakota agricultural workers and farmers in central North Dakota at risk and/or suffering from NIHL; b)provide education related to prevention of noise induced hearing loss and the use of hearing protection devices (HPDs); and c) promote referral to an appropriate health care provider. The Hear X hearScreen audiometric tool was utilized to help establish routine screening in a rural healthcare clinic. The project included using a pre-survey demographics questionnaire, the Hearing Handicap Inventory-Adult questionnaire and the Hear X hearScreen audiometric tool. Using these screening tools individuals’ perceptions of hearing loss were compared to their actual hearing loss in a rural clinic setting in Steele, ND. Screening data revealed that 72% of participants indicated a perceived hearing loss. Upon completion of the Hear X hearScreen audiometric tool, 72% of these same participants tested positive for some form of hearing loss. Over 96% of participants indicated exposure to loud noise greater than 85dB daily. Unfortunately, 36% of participants indicated no hearing protection device (HPD) use. 47% reported using HPD sometimes, and 21% reported wearing HPD most of the time. Zero participants reported wearing HPDs all the time. All participants were provided with verbal and written information regarding the use of HPDs as well as a document listing audiology providers within 100-miles of the rural health clinic if they were interested in further testing or treatment.