Summary Background and Objectives Chinas rural environment has changed drastically since 1978.The new rural cooperative health care scheme covers 97% of farmers in 2011,1 village medical posts have been reestablished almost in every administrative village, new social support scheme ensures that every elder over 60 years has basic old pension.At the same time, many young farmers have migrated to urban areas, and peoples value orientation has changed driven by the market economy.Several policies benefiting agriculture and farmers, such as exemption from agricultural taxation, machinery subsidies, and improvements in infrastructure such as transportation and sanitation have been implemented.Many studies have evaluated the effects of these reforms from the macro viewpoint,8,9 but few have analyzed the effects from a grassroots viewpoint.Therefore, this study focused on stroke survivors in rural areas—a group characterized by long-term disability, advanced age, and little or no income.Through visiting and interviewing stroke survivors at their homes with the focus on their activity, participation, and the environmental factors that effect them, the study was designed to reveal the real life status of rural stroke survivors and to record and clarify the effects of environmental barriers on their activity and participation.Methods A cross-sectional survey of 290 stroke survivors and 71 control subjects was conducted in two counties in Guangdong province, China.Their sociodemographics and stroke-related characteristics, cognitive function, activity and participation, and environmental barriers were all investigated using self-designed questionnaire, AMT, WHODAS2.0, and CHIEF, respectively.These variables were compared between the stroke and control groups.Environmental effects on the activity and participation of stroke survivors were analyzed using linear regression.Results Significant differences in activity and participation between the stroke and control groups were documented.Environmental barriers accounted for 10·1% of the variance in activity and 28·3% of the variance in participation after controlling for age, gender, education level, marital status, and cognition.Conclusions Stroke survivors in rural China lead a poor and isolated life.Although recent reforms have greatly benefited farmers, environmental factors still create high barriers to activity and participation for stroke survivors.Support for home modification, organizations working for the elderly and disabled people, social providing for the aged, and rehabilitation support at home should be futrther reinforced and expanded.