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OBJECTIVE: To determine the effect of a voucher for free mammography on compliance with recommended mammography screening guidelines. STUDY DESIGN: Vouchers for free mammography distributed to a random sample of women over the age of 50 in two rural southern Minnesota counties. The vouchers were good for one year. Baseline and follow-up data were collected and rates of compliance with current mammography guidelines were observed for the voucher group and a control group of women living in the same counties. METHODS: Logistic regression models were used to estimate the effect of the voucher on compliance with mammography guidelines and the impact of factors potentially influencing the effectiveness of the voucher. PRINCIPAL FINDINGS: The voucher improved mammography rates primarily through increasing screening among women who were out of compliance at baseline. CONCLUSIONS: Vouchers, even when distributed randomly within a population of rural Midwestern women, can significantly improve compliance rates. Vouchers are no less effective a means of increasing screening among vulnerable women than among other women.