BACKGROUND: Agriculture is one of the most hazardous industries in the US. METHODS: We reviewed MEDLINE and NIOSHTIC to identify English-language studies addressing occupational injury among agricultural populations, focusing on North America. Additional references were identified from the reference lists of identified studies and from contacts with experts in the field. RESULTS: U.S. data indicate up to approximately 780 deaths and 140,000 cases of nonfatal disabling injuries in 1998. Risk of agricultural injuries is approximately 5-10/100 persons per year, but is higher in certain risk groups, such as males and cattle workers. Falls, machinery, and animals are among the most common causes. Unique features of the agricultural workplace and exposed population combine to increase risk and hinder accurate measurement. These features include a wide range of activities, hazards, and dispersed work places in agriculture; a seasonal hired work force that often has brief tenure, poor English skills, and a distrust of officialdom; and a history of exemption regarding occupational health and safety regulations. CONCLUSIONS: Research in agricultural injury should include epidemiologic study of risk factors and evaluation of interventions. Although only limited data are available documenting efficacy of specific preventive approaches, prevention should focus on engineering controls, regulatory approaches, and education.