Purpose To assess the prevalence of refractive errors, including myopia, high myopia, hyperopia, astigmatism, and anisometropia, in rural adult Koreans. Methods We identified 2027 residents aged 40 years or older in Namil-myeon, a rural town in central South Korea. Of 1928 eligible residents, 1532 subjects (79.5%) participated. Each subject underwent screening examinations including autorefractometry, corneal curvature measurement, and best-corrected visual acuity. Results Data from 1215 phakic right eyes were analyzed. The prevalence of myopia (spherical equivalent (SE) o À 0.5 diopters (D)) was 20.5% (95% confidence interval (CI): 18.2 À 22.8%), of high myopia (SE o À 6.0 D) was 1.0% (95% CI: 0.4 À 1.5%), of hyperopia (SE4 þ 0.5 D) was 41.8% (95% CI: 38.9 À 44.4%), of astigmatism (cylinder o À 0.5 D) was 63.7% (95% CI: 61.0 À 66.4%), and of anisometropia (difference in SE between eyes 41.0 D) was 13.8% (95% CI: 11.9 À 15.8%). Myopia prevalence decreased with age and tended to transition into hyperopia with age up to 60 À 69 years. In subjects older than this, the trend in SE refractive errors reversed with age. The prevalence of astigmatism and anisometropia increased consistently with age. The refractive status was not significantly different between males and females. Conclusions The prevalence of myopia and hyperopia in rural adult Koreans was similar to that of rural Chinese. The prevalence of high myopia was lower in this Korean sample than in other East Asian populations, and astigmatism was the most frequently occurring refractive error.