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The adherence to published guidelines for diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD) by primary care pediatricians (PDs) and family practice physicians (FPs), particularly those in rural areas, has not been well documented. This study examined survey responses from PDs and FPs who serve southern Appalachia (northeast Tennessee, southwest Virginia and Kentucky, and western North Carolina) regarding key practice parameters in line with the current American Academy of Pediatrics guidelines. Results showed that both PDs and FPs reported adhering to most of the diagnosis and treatment guidelines. PDs were more likely than FPs to report using both parent and teacher input in diagnosis and reported prescribing different medications for ADHD to some degree. Both practice areas reported ongoing access to continuing medical education, which is a means to enhancing care of ADHD patients. Implications for primary care are given with attention to the limited availability of PDs in rural areas and future areas of research in rural mental healthcare are suggested.