College adjustment is particularly challenging for students from rural Appalachia, causing rural students to be more likely than their suburban and urban peers to withdraw from college. However, little is known about rural Appalachian college students' adjustment. We explored 18 rural Appalachian students' college adjustment experiences and categorized findings into five major themes: cultural fit and feel, embracing agency, Appalachian identification, academic barriers, and pressure. Implications for practice and future research are provided.