Expected growth in the population of rural areas of California and in the number of jobs in middle-skill occupations has increased interest in the alignment of middle-skill workforce supply and occupational demand, particularly in rural regions. This study focuses on that alignment in four rural regions of the state: Central Valley and Mother Lode North, Central Valley and Mother Lode South, Northern Coastal, and Northern Inland. Middle-skill occupations are those that require a typical entry-level education greater than a high school diploma but less than a bachelor's degree. The study found that across the four regions combined, nearly 84,000 job openings in middle-skill occupations were projected for each year in 2018-20, or about 31 percent of all job openings in the four regions. The number of jobs was projected to grow in an average of 70 percent of middle-skill occupations. About 90 percent of job openings in middle-skill occupations paid a living wage at entry level in 2017. However, local postsecondary institutions were not producing enough credentialed middle-skill workers to fill projected new jobs and replace workers who retire, change jobs, or otherwise leave their job. Each year in 2014/15-2016/17, postsecondary institutions in the four regions awarded an average of nearly 20,100 middle-skill credentials (a subbaccalaureate credential that is awarded by a postsecondary institution and aligned with a middle-skill occupation). Assuming that the rate of credential awards persisted and that no other supply of middle-skill labor emerged, the average local credential deficit each year in 2018-20 was projected to be 63,665, or 76 percent of projected job openings in middle-skill occupations each year. Only 5 of the 50 most in-demand middle-skill occupations were projected to experience a local credential surplus. The analyses were conducted prior to the COVID-19 pandemic, and the findings do not include its influence on the supply and demand of the middle-skill labor market. [For the appendixes, see ED608886; for the study snapshot, see ED608884.]