African American youth in the US rural South are at elevated risk for poor sexual health outcomes, including sexually transmitted infections and teenage pregnancy. Historically, the southeastern USA has lagged behind in providing comprehensive sexuality-based education in secondary school, which may contribute to poor reproductive and sexual health outcomes. This study aimed to understand the perspectives of African American youth and adults on comprehensive sexuality-based education in rural North Carolina. Twenty-four individuals (12 youth and 12 adults) participated in both semi-structured interviews and small discussion groups. Data were analysed and coded using inductive and deductive approaches to thematic analysis. Results indicated that comprehensive sexuality-based education was viewed as highly desirable; however, current efforts were seen as insufficient. While both young people and adults agreed that abstinence was the most desirable path for youth, participants also acknowledged young people's autonomy in engaging in sexual activity and suggested that comprehensive sexuality-based education was needed to protect against unintended consequences. The findings of this study have practical implications for addressing challenges associated with providing sexuality-based education to African American youth in rural communities and offers suggestions regarding directions for future research.