Motor vehicle crashes are the leading cause of work-related fatality in the U.S. as well as in the oil and gas extraction industry. This study describes the characteristics of motor vehicle-related fatalities in the oil and gas extraction industry using data from the U.S. Bureau of Labor Statistics’ Census of Fatal Occupational Injuries. It compares the risk of dying in a motor vehicle crash in this industry to other major industries and among different types and sizes of oil and gas extraction companies. There were 202 oil and gas extraction workers who died in a work-related motor vehicle crash from 2003 to 2009. The motor vehicle fatality rate for workers in this industry was 8.5 times that of all private wage and salary workers (7.6 vs. 0.9, p < .0001). Workers from small oil and gas establishments (<20 workers) and workers from well-servicing companies were at greatest risk of dying in a motor vehicle crash. Pick-up trucks were the most frequent type of vehicle occupied by the fatally injured worker (n = 104, 51.5%). Safety belt non-use was identified in 38.1% (n = 77) of the cases. Increased focus on motor vehicle safety in this industry is needed, in particular among small establishments. Extraction workers who drive light duty vehicles need to be a specific focus.